what is the importance of sexuality education

Comprehensive sexuality education: For healthy, informed and empowered learners

Did you know that only 37% of young people in sub-Saharan Africa can demonstrate comprehensive knowledge about HIV prevention and transmission? And two out of three girls in many countries lack the knowledge they need as they enter puberty and begin menstruating? Early marriage and early and unintended pregnancy are global concerns for girls’ health and education: in East and Southern Africa pregnancy rates range 15-25%, some of the highest in the world. These are some of the reasons why quality comprehensive sexuality education (CSE) is essential for learners’ health, knowledge and empowerment. 

What is comprehensive sexuality education or CSE?

Comprehensive sexuality education - or the many other ways this may be referred to - is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that empowers them to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.

CSE presents sexuality with a positive approach, emphasizing values such as respect, inclusion, non-discrimination, equality, empathy, responsibility and reciprocity. It reinforces healthy and positive values about bodies, puberty, relationships, sex and family life.

How can CSE transform young people’s lives?

Too many young people receive confusing and conflicting information about puberty, relationships, love and sex, as they make the transition from childhood to adulthood. A growing number of studies show that young people are turning to the digital environment as a key source of information about sexuality.

Applying a learner-centered approach, CSE is adapted to the age and developmental stage of the learner. Learners in lower grades are introduced to simple concepts such as family, respect and kindness, while older learners get to tackle more complex concepts such as gender-based violence, sexual consent, HIV testing, and pregnancy.

When delivered well and combined with access to necessary sexual and reproductive health services, CSE empowers young people to make informed decisions about relationships and sexuality and navigate a world where gender-based violence, gender inequality, early and unintended pregnancies, HIV and other sexually transmitted infections still pose serious risks to their health and well-being. It also helps to keep children safe from abuse by teaching them about their bodies and how to change practices that lead girls to become pregnant before they are ready.

Equally, a lack of high-quality, age-appropriate sexuality and relationship education may leave children and young people vulnerable to harmful sexual behaviours and sexual exploitation.

What does the evidence say about CSE?

The evidence on the impact of CSE is clear:

• Sexuality education has positive effects, including increasing young people’s knowledge and improving their attitudes related to sexual and reproductive health and behaviors.
• Sexuality education leads to learners delaying the age of sexual initiation, increasing the use of condoms and other contraceptives when they are sexually active, increasing their knowledge about their bodies and relationships, decreasing their risk-taking, and decreasing the frequency of unprotected sex.
• Programmes that promote abstinence as the only option have been found to be ineffective in delaying sexual initiation, reducing the frequency of sex or reducing the number of sexual partners. To achieve positive change and reduce early or unintended pregnancies, education about sexuality, reproductive health and contraception must be wide-ranging.
• CSE is five times more likely to be successful in preventing unintended pregnancy and sexually transmitted infections when it pays explicit attention to the topics of gender and power
• Parents and family members are a primary source of information, values formation, care and support for children. Sexuality education has the most impact when school-based programmes are complemented with the involvement of parents and teachers, training institutes and youth-friendly services .

How does UNESCO work to advance learners' health and education?

Countries have increasingly acknowledged the importance of equipping young people with the knowledge, skills and attitudes to develop and sustain positive, healthy relationships and protect themselves from unsafe situations.

UNESCO believes that with CSE, young people learn to treat each other with respect and dignity from an early age and gain skills for better decision making, communications, and critical analysis. They learn they can talk to an adult they trust when they are confused about their bodies, relationships and values. They learn to think about what is right and safe for them and how to avoid coercion, sexually transmitted infections including HIV, and early and unintended pregnancy, and where to go for help. They learn to identify what violence against children and women looks like, including sexual violence, and to understand injustice based on gender. They learn to uphold universal values of equality, love and kindness.

In its International Technical Guidance on Sexuality Education , UNESCO and other UN partners have laid out pathways for quality CSE to promote health and well-being, respect for human rights and gender equality, and empower children and young people to lead healthy, safe and productive lives. An online toolkit was developed by UNESCO to facilitate the design and implementation of CSE programmes at national level, as well as at local and school level. A tool for the review and assessment of national sexuality education programmes is also available. Governments, development partners or civil society organizations will find this useful. Guidance for delivering CSE in out-of-school settings is also available.

Through its flagship programme, Our rights, Our lives, Our future (O3) , UNESCO has reached over 30 million learners in 33 countries across sub-Saharan Africa with life skills and sexuality education, in safer learning environments. O3 Plus is now also reaching and supporting learners in higher education institutions.

To strengthen coordination among the UN community, development partners and civil society, UNESCO is co-convening the Global partnership forum on CSE together with UNFPA. With over 65 organizations in its fold, the partnership forum provides a structured platform for intensified collaboration, exchange of information and good practices, research, youth advocacy and leadership, and evidence-based policies and programmes.

Good quality CSE delivery demands up to date research and evidence to inform policy and implementation . UNESCO regularly conducts reviews of national policies and programmes – a report found that while 85% of countries have policies that are supportive of sexuality education, significant gaps remain between policy and curricula reviewed. Research on the quality of sexuality education has also been undertaken, including on CSE and persons with disabilities in Asia and East and Southern Africa .

How are young people and CSE faring in the digital space?

More young people than ever before are turning to digital spaces for information on bodies, relationships and sexuality, interested in the privacy and anonymity the online world can offer. UNESCO found that, in a year, 71% of youth aged 15-24 sought sexuality education and information online.

With the rapid expansion in digital information and education, the sexuality education landscape is changing . Children and young people are increasingly exposed to a broad range of content online some of which may be incomplete, poorly informed or harmful.

UNESCO and its Institute of Information Technologies in Education (IITE) work with young people and content creators to develop digital sexuality education tools that are of good quality, relevant and include appropriate content. More research and investment are needed to understand the effectiveness and impact of digital sexuality education, and how it can complement curriculum-based initiatives. Part of the solution is enabling young people themselves to take the lead on this, as they are no longer passive consumers and are thinking in sophisticated ways about digital technology.

A foundation for life and love

• Safe, seen and included: report on school-based sexuality education
• International Technical Guidance on Sexuality Education
• Safe, seen and included: inclusion and diversity within sexuality education; briefing note
• Comprehensive sexuality education (CSE) country profiles
• Evidence gaps and research needs in comprehensive sexuality education: technical brief
• The journey towards comprehensive sexuality education: global status report
• Definition of Sustainable Development Goal (SDG) thematic indicator 4.7.2: Percentage of schools that provided life skills-based HIV and sexuality education within the previous academic year
• From ideas to action: addressing barriers to comprehensive sexuality education in the classroom
• Facing the facts: the case for comprehensive sexuality education
• UNESCO strategy on education for health and well-being
• UNESCO Health and education resource centre
• Campaign: A foundation for life and love
• UNESCO’s work on health and education

Related items

• Health education
• Sex education

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The Importance of Access to Comprehensive Sex Education

Comprehensive sex education is a critical component of sexual and reproductive health care.

Developing a healthy sexuality is a core developmental milestone for child and adolescent health.

Youth need developmentally appropriate information about their sexuality and how it relates to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

AAP supports broad access to comprehensive sex education, wherein all children and adolescents have access to developmentally appropriate, evidence-based education that provides the knowledge they need to:

• Develop a safe and positive view of sexuality.
• Build healthy relationships.
• Make informed, safe, positive choices about their sexuality and sexual health.

Comprehensive sex education involves teaching about all aspects of human sexuality, including:

• Cyber solicitation/bullying.
• Healthy sexual development.
• Body image.
• Sexual orientation.
• Gender identity.
• Pleasure from sex.
• Sexual abuse.
• Sexual behavior.
• Sexual reproduction.
• Sexually transmitted infections (STIs).
• Abstinence.
• Contraception.
• Interpersonal relationships.
• Reproductive coercion.
• Reproductive rights.
• Reproductive responsibilities.

Comprehensive sex education programs have several common elements:

• Utilize evidence-based, medically accurate curriculum that can be adapted for youth with disabilities.
• Employ developmentally appropriate information, learning strategies, teaching methods, and materials.
• Human development , including anatomy, puberty, body image, sexual orientation, and gender identity.
• Relationships , including families, peers, dating, marriage, and raising children.
• Personal skills , including values, decision making, communication, assertiveness, negotiation, and help-seeking.
• Sexual behavior , including abstinence, masturbation, shared sexual behavior, pleasure from esx, and sexual dysfunction across the lifespan.
• Sexual health , including contraception, pregnancy, prenatal care, abortion, STIs, HIV and AIDS, sexual abuse, assault, and violence.
• Society and culture , including gender roles, diversity, and the intersection of sexuality and the law, religion, media, and the arts.
• Create an opportunity for youth to question, explore, and assess both personal and societal attitudes around gender and sexuality.
• Focus on personal practices, skills, and behaviors for healthy relationships, including an explicit focus on communication, consent, refusal skills/accepting rejection, violence prevention, personal safety, decision making, and bystander intervention.
• Help youth exercise responsibility in sexual relationships.
• Include information on how to come forward if a student is being sexually abused.
• Address education from a trauma-informed, culturally responsive approach that bridges mental, emotional, and relational health.

Comprehensive sex education should occur across the developmental spectrum, beginning at early ages and continuing throughout childhood and adolescence :

• Sex education is most effective when it begins before the initiation of sexual activity.
• Young children can understand concepts related to bodies, gender, and relationships.
• Sex education programs should build an early foundation and scaffold learning with developmentally appropriate content across grade levels.
• AAP Policy outlines considerations for providing developmentally appropriate sex education throughout early childhood, middle childhood, adolescence, and young adulthood.

Most adolescents report receiving some type of formal sex education before age 18. While sex education is typically associated with schools, comprehensive sex education can be delivered in several complementary settings:

• Schools can implement comprehensive sex education curriculum across all grade levels
• The Sexuality Information and Education Council of the United States (SIECUS) provides guidelines for providing developmentally appropriate comprehensive sex education across grades K-12.
• Pediatric health clinicians and other health care providers are uniquely positioned to provide longitudinal sex education to children, adolescents, and young adults.
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents outlines clinical considerations for providing comprehensive sex education at all developmental stages, as a part of preventive health care.
• Research suggests that community-based organizations should be included as a source for comprehensive sexual health promotion.
• Faith-based communities have developed sex education curricula for their congregations or local chapters that emphasize the moral and ethical aspects of sexuality and decision-making.
• Parents and caregivers can serve as the primary sex educators for their children, by teaching fundamental lessons about bodies, development, gender, and relationships.
• Many factors impact the sex education that youth receive at home, including parent/caregiver knowledge, skills, comfort, culture, beliefs, and social norms.
• Virtual sex education can take away feelings of embarrassment or stigma and can allow for more youth to access high quality sex education.

Comprehensive sex education provides children and adolescents with the information that they need to:

• Understand their body, gender identity, and sexuality.
• Build and maintain healthy and safe relationships.
• Engage in healthy communication and decision-making around sex.
• Practice healthy sexual behavior.
• Understand and access care to support their sexual and reproductive health.

Comprehensive sex education programs have demonstrated success in reducing rates of sexual activity, sexual risk behaviors, STIs, and adolescent pregnancy and delaying sexual activity. Many systematic reviews of the literature have indicated that comprehensive sex education promotes healthy sexual behaviors:

• Reduced sexual activity.
• Reduced number of sexual partners.
• Reduced frequency of unprotected sex.
• Increased condom use.
• Increased contraceptive use.

However, comprehensive sex education curriculum goes beyond risk-reduction, by covering a broader range of content that has been shown to support social-emotional learning, positive communication skills, and development of healthy relationships.

A 2021 review of the literature found that comprehensive sex education programs that use a positive, affirming, and inclusive approach to human sexuality are associated with concrete benefits across 5 key domains:

Benefits of comprehensive sex education programs 

When children and adolescents lack access to comprehensive sex education, they do not get the information they need to make informed, healthy decisions about their lives, relationships, and behaviors.

Several trends in sexual health in the US highlight the need for comprehensive sex education for all youth.

Education about condom and contraceptive use is needed:

• 55% of US high school students report having sexual intercourse by age 18 .
• Self-reported condom use has decreased significantly among high school students.
• Only 9% of sexually active high school students report using both a condom for STI-prevention and a more effective form of birth control to prevent pregnancy .

STI prevention is needed:

• Adolescents and young adults are disproportionately impacted by STIs.
• Cases of chlamydia, gonorrhea, and syphilis are rising rapidly among young people.
• When left untreated , these infections can lead to infertility, adverse pregnancy and birth outcomes, and increased risk of acquiring new STIs.
• Youth need comprehensive, unbiased information about STI prevention, including human papillomavirus (HPV) .

Continued prevention of unintended pregnancy is needed:

• Overall US birth rates among adolescent mothers have declined over the last 3 decades.
• There are significant geographic disparities in adolescent pregnancy rates, with higher rates of pregnancy in rural counties and in southern and southwestern states.
• Social drivers of health and systemic inequities have caused racial and ethnic disparities in adolescent pregnancy rates.
• Eliminating disparities in adolescent pregnancy and birth rates can increase health equity, improve health and life outcomes, and reduce the economic impact of adolescent parenting.

Misinformation about sexual health is easily available online:

• Internet use is nearly universal among US children and adolescents.
• Adolescents report seeking sexual health information online .
• Sexual health websites that adolescents visit can contain inaccurate information .

Prevention of sex abuse, dating violence, and unhealthy relationships is needed:

• Child sexual abuse is common: 25% of girls and 8% of boys experience sexual abuse during childhood .
• Youth who experience sexual abuse have long-term impacts on their physical, mental, and behavioral health.
• 1 in 11 female and 1 in 14 male students report physical DV in the last year .
• 1 in 8 female and 1 in 26 male students report sexual DV in the last year .
• Youth who experience DV have higher rates of anxiety, depression, substance use, antisocial behaviors, and suicide risk.

The quality and content of sex education in US schools varies widely.

There is significant variation in the quality of sex education taught in US schools, leading to disparities in attitudes, health information, and outcomes. The majority of sex education programs in the US tend to focus on public health goals of decreasing unintended pregnancies and preventing STIs, via individual behavior change.

There are three primary categories of sex educational programs taught in the US :

• Abstinence-only education , which teaches that abstinence is expected until marriage and typically excludes information around the utility of contraception or condoms to prevent pregnancy and STIs.
• Abstinence-plus education , which promotes abstinence but includes information on contraception and condoms.
• Comprehensive sex education , which provides medically accurate, age-appropriate information around development, sexual behavior (including abstinence), healthy relationships, life and communication skills, sexual orientation, and gender identity.

State laws impact the curriculum covered in sex education programs. According to a report from the Guttmacher Institute :

• 26 US states and Washington DC mandate sex education and HIV education.
• 18 states require that sex education content be medically accurate.
• 39 states require that sex education programs provide information on abstinence.
• 20 states require that sex education programs provide information on contraception.

US states have varying requirements on sex education content related to sexual orientation :

• 10 states require sex education curriculum to include affirming content on LGBTQ2S+ identities or discussion of sexual health for youth who are LGBTQ2S+.
• 7 states have sex education curricular requirements that discriminate against individuals who are LGBTQ2S+.Youth who live in these states may face additional barriers to accessing sexual health information.

Abstinence-only sex education programs do not meet the needs of children and adolescents.

While abstinence is 100% effective in preventing pregnancy and STIs, research has conclusively shown that abstinence-only sex education programs do not support healthy sexual development in youth.

Abstinence-only programs are ineffective in reaching their stated goals, as evidenced by the data below:

• Abstinence-only programs are unsuccessful in delaying sex until marriage .
• Abstinence-only sex education programs do not impact the rates of pregnancy, STIs, or HIV in adolescents .
• Youth who take a “virginity pledge” as part of abstinence-only education programs have the same rates of premarital sex as their peers who do not take pledges, but are less likely to use contraceptives .
• US states that emphasize abstinence-only education have higher rates of adolescent pregnancy and birth .

Abstinence-only programs can harm the healthy sexual and mental development of youth by:

• Withholding information or providing inaccurate information about sexuality and sexual behavior .
• Contributing to fear, shame, and stigma around sexual behaviors .
• Not sharing information on contraception and barrier protection or overstating the risks of contraception .
• Utilizing heteronormative framing and stigma or discrimination against students who are LGBTQ2S+ .
• Reinforcing harmful gender stereotypes .
• Ignoring the needs of youth who are already sexually active by withholding education around contraception and STI prevention.

Abstinence-plus sex education programs focus solely on decreasing unintended pregnancy and STIs.

Abstinence-plus sex education programs promote abstinence until marriage. However, these programs also provide information on contraception and condom use to prevent unintended pregnancy and STIs.

Research has demonstrated that abstinence-plus programs have an impact on sexual behavior and safety, including:

• HIV prevention.
• Increase in condom use .
• Reduction in number of sexual partners .
• Delay in initiation of sexual behavior .

While these programs add another layer of education, they do not address the broader spectrum of sexuality, gender identity, and relationship skills, thus withholding critical information and skill-building that can impact healthy sexual development.

AAP and other national medical and public health associations support comprehensive sex education for youth.

Given the evidence outlined above, AAP and other national medical organizations oppose abstinence-only education and endorse comprehensive sex education that includes both abstinence promotion and provision of accurate information about contraception, STIs, and sexuality.

National medical and public health organizations supporting comprehensive sex education include:

• American Academy of Pediatrics .
• American Academy of Family Physicians.
• American College of Obstetricians and Gynecologists .
• American Medical Association .
• American Public Health Association .
• Society for Adolescent Health and Medicine .

Pediatric clinics provide a unique opportunity for comprehensive sex education.

Pediatric health clinicians typically have longitudinal care relationships with their patients and families, and thus have unique opportunities to address comprehensive sex education across all stages of development.

The clinical visit can serve as a useful adjunct to support comprehensive sex education provided in schools, or to fill gaps in knowledge for youth who are exposed to abstinence-only or abstinence-plus curricula.

AAP policy and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents provide recommendations for comprehensive sex education in clinical settings, including:

• Encouraging parent-child discussions on sexuality, contraception, and internet/media use.
• Understanding diverse experiences and beliefs related to sexuality and sex education and meeting the unique needs of individual patients and families.
• Including discussions around healthy relationships, dating violence, and intimate partner violence in clinical care.
• Discussing methods of contraception and STI/HPV prevention prior to onset of sexual intercourse.
• Providing proactive and developmentally appropriate sex education to all youth, including children and adolescents with special health care needs.

Perspective

Karen Torres, Youth activist

There were two cardboard bears, and a person explained that one bear wears a bikini to the beach and the other bear wears shorts – that is the closest thing I ever got to sex ed throughout my entire K-12 education. I often think about that bear lesson because it was the day our institutions failed to teach me anything about my body, relationships, consent, and self-advocacy, which became even more evident after I was sexually assaulted at 16 years old. My story is not unique, I know that many young people have been through similar traumas, but many of us were also subjected to days, months, and years of silence and embarrassment because we were never given the knowledge to know how to spot abuse or the language to ask for help. Comprehensive sex ed is so much more than people make it out to be, it teaches about sex but also about different types of experiences, how to respect one another, how to communicate in uncomfortable situations, how to ask for help and an insurmountable amount of other valuable lessons.

From these lessons, people become well-rounded, people become more empathetic to other experiences, and people become better. I believe comprehensive sex ed is vital to all people and would eventually work as a part to build more compassionate communities.

Many US children and adolescents do not receive comprehensive sex education; and rates of formal sex education have declined significantly in recent decades.

Barriers to accessing comprehensive sex education include:

Misinformation, stigma, and fear of negative reactions:

• Misinformation and stigma about the content of sex education curriculum has been the primary barrier to equitable access to comprehensive sex education in schools for decades .
• Despite widespread parental support for sex education in schools, fears of negative public/parent reactions have led school administrators to limit youth access to the information they need to make healthy decisions about their sexuality for nearly a half-century.
• In recent years, misinformation campaigns have spread false information about the framing and content of comprehensive sex education programs, causing debates and polarization at school board meetings .
• Nearly half of sex education teachers report that concerns about parent, student, or administrator responses are a barrier to provision of comprehensive sex education.
• Opponents of comprehensive sex education often express concern that this education will lead youth to have sex; however, research has demonstrated that this is not the case . Instead, comprehensive sex ed is associated with delays in initiation of sexual behavior, reduced frequency of sexual intercourse, a reduction in number of partners, and an increase in condom use.
• Some populations of youth lack access to comprehensive sex education due to a societal belief that they are asexual, in need of protection, or don’t need to learn about sex. This barrier particularly impacts youth with disabilities or special health care needs .
• Sex ed curricula in some schools perpetuate gender/sex stereotypes, which could contribute to negative gender stereotypes and negative attitudes towards sex .

Inconsistencies in school-based sex education:

• There is significant variation in the content of sex education taught in schools in the US, and many programs that carry the same label (eg, “abstinence-plus”) vary widely in curriculum.
• While decisions about sex education curriculum are made at the state level, the federal government has provided funding to support abstinence-only education for decades , which incentivizes schools to use these programs.
• Since 1996, more than $2 billion in federal funds have been spent to support abstinence-only sex education in schools.
• 34 US states require schools to use abstinence-only curriculum or emphasize abstinence as the main way to avoid pregnancy and STIs.
• Only 16 US states require instruction on condoms or contraception.
• It is not standard to include information on how to come forward if a student is being sexually abused, and many schools do not have a process for disclosures made.
• Because of this, abstinence-only programs are commonly used in US schools, despite overwhelming evidence that they are ineffective in delaying sexual behavior until marriage, and withhold critical information that youth need for healthy sexual and relationship development.

Need for resources and training:

• Integration of comprehensive sex education into school curriculum requires financial resources to strengthen and expand evidence-based programs.
• Successful implementation of comprehensive sex education requires a trained workforce of teachers who can address the curriculum in age-appropriate ways for students in all grade-levels.
• Education, training, and technical assistance are needed to support pediatric health clinicians in addressing comprehensive sex education in clinical settings, as a complement to school-based education.

Lack of diversity and cultural awareness in curricula:

• A history of systemic racism, discrimination, and long-standing health, social and systemic inequities have created racial and ethnic disparities in access to sexual health services and representation in sex education materials. The legacy of intergenerational trauma in the medical system should be acknowledged in sex education curricula.
• Sex education curriculum is often centered on a white audience, and does not address or reflect the role of systemic racism in sexuality and development .
• Traditional abstinence-focused sex education programs have a heteronormative focus and do not address the unique needs of youth who are LGBTQ2S+ .
• Sex education programs often do not address reproductive body diversity, the needs of those with differences in sex development, and those who identify as intersex .
• Sex education programs often do not reflect the unique needs of youth with disabilities or special health care needs .
• Sex education programs are often not tailored to meet the religious considerations of faith communities.
• There is a need for sex education programs designed to help youth navigate sexual health and development in the context of their own culture and community .

Disparities in access to comprehensive sex education.

The barriers listed above limit access to comprehensive sex education in schools and communities. While these barriers impact youth across the US, there are some populations who are less likely to have access to comprehensive to sex education.

Youth who are LGBTQ2S+:

• Only 8% of students who are LGBTQ2S+ report having received sexual education that was inclusive .
• Students who are LGBTQ2S+ are 50% more likely than their peers who are heterosexual to report that sex education in their schools was not useful to them .
• Only 13% of youth who are bisexual+ and 10% of youth who are transgender and gender expansive report receiving sex education in schools that felt personally relevant.
• Only 20% of youth who are Black and LGBTQ2S+ and 13% of youth who are Latinx and LGBTQ2S+ report receiving sex education in schools that felt personally relevant.
• Only 10 US states require affirming content on LGBTQ2S+ relationships in sex education curriculum.

Youth with disabilities or special health care needs:

• Youth with disabilities or special health care needs have a particular need for comprehensive sex education, as these youth are less likely to learn about sex or sexuality form their parents , healthcare providers , or peer groups .
• In a national survey, only half of youth with disabilities report that they have participated in sex education .
• Typical sex education may not be sufficient for youth with Autism Spectrum Disorder, and special methods and curricula are necessary to match their needs .
• Lack the desire or maturity for romantic or sexual relationships.
• Are not subject to sexual abuse.
• Do not need sex education.
• Only 3 states explicitly include youth with disabilities within their sex education requirements.

Youth from historically underserved communities:

• Students who are Black in the US are more likely than students who are white to receive abstinence-only sex education , despite significant support from parents and students who are Black for comprehensive sex education.
• Youth who are Black and female are less likely than peers who are white to receive education about where to obtain birth control prior to initiating sexual activity.
• Youth who are Black and male and Hispanic are less likely than their peers who are white to receive formal education on STI prevention or contraception prior to initiating sexual activity.
• Youth who are Hispanic and female are less likely to receive instruction about waiting to have sex than youth of other ethnicities.
• Tribal health educators report challenges in identifying culturally relevant sex education curriculum for youth who are American Indian/Alaska Native.
• In a 2019 study, youth who were LGBTQ2S+ and Black, Latinx, or Asian reported receiving inadequate sex education due to feeling unrepresented, unsupported, stigmatized, or bullied.
• In survey research, many young adults who are Asian American report that they received inadequate sex education in school.

Youth from rural communities:

• Adolescents who live in rural communities have faced disproportionate declines in formal sex education over the past two decades, compared with peers in urban/suburban areas.
• Students who live in rural communities report that the sex education curriculum in their schools does not serve their needs .

Youth from communities and schools that are low-income:

• Data has shown an association between schools that are low-resource and lower adolescent sexual health knowledge, due to a combination of fewer school resources and higher poverty rates/associated unmet health needs in the student body.
• Youth with family incomes above 200% of the federal poverty line are more likely to receive education about STI prevention, contraception, and “saying no to sex,” than their peers below 200% of the poverty line.

Youth who receive sex education in some religious settings:

• Most adolescents who identify as female and who attended church-based sex education programs report instructions on waiting until marriage for sex, while few report receiving education about birth control.
• Young people who received sex education in religious schools report that education focused on the risks of sexual behavior (STIs, pregnancy) and religious guilt; leading to them feeling under-equipped to make informed decisions about sex and sexuality later in life.
• Youth and teachers from religious schools have identified a need for comprehensive sex education curriculum that is tailored to the needs of faith communities .

Youth who live in states that limit the topics that can be covered in sex education:

• Students who live in the 34 states that require sex education programs to stress abstinence are less likely to have access to critical information on STI prevention and contraception.
• Prohibitions on addressing abortion in sex education or mandates that sex education curricula include medically inaccurate information on abortion designed to dissuade youth from terminating a pregnancy.
• Limitations on the types of contraception that can be covered in sex education curricula.
• Requirements that sex education teachers promote heterosexual, monogamous marriage in sex education.
• Lack of requirements to address healthy relationships and communication skills.
• Lack of requirements for teacher training or certification.

Comprehensive sex education has significant benefits for children and adolescents.

Youth who are exposed to comprehensive sex education programs in school demonstrate healthier sexual behaviors:

• Increased rates of contraception and condom use.
• Fewer unplanned pregnancies.
• Lower rates of STIs and HIV.
• Delayed initiation of sexual behavior.

More broadly, comprehensive sexual education impacts overall social-emotional health , including:

• Enhanced understanding of gender and sexuality.
• Lower rates of homophobia and related bullying.
• Lower rates of dating violence, intimate partner violence, sexual assault, and child sexual abuse.
• Healthier relationships and communication skills.
• Understanding of reproductive rights and responsibilities.
• Improved social-emotional learning, media literacy, and academic achievement.

Comprehensive sex education curriculum goes beyond risk reduction, to ensure that youth are supported in understanding their identity and sexuality and making informed decisions about their relationships, behaviors, and future. These benefits are critical to healthy sexual development.

Impacts of a lack of access to comprehensive sex education.

When youth are denied access to comprehensive sex education, they do not get the information and skill-building required for healthy sexual development. As such, they face unnecessary barriers to understanding their gender and sexuality, building positive interpersonal relationships, and making informed decisions about their sexual behavior and sexual health.

Impacts of a lack of comprehensive sex education for all youth can include :

• Less use of condoms, leading to higher risk of STIs, including HIV.
• Less use of contraception, leading to higher risk of unplanned pregnancy.
• Less understanding and increased stigma and shame around the spectrum of gender and sexual identity.
• Perpetuated stigma and embarrassment related to sex and sexual identity.
• Perpetuated gender stereotypes and traditional gender roles.
• Higher rates of youth turning to unreliable sources for information about sex, including the internet, the media, and informal learning from peer networks.
• Challenges in interpersonal communication.
• Challenges in building, maintaining, and recognizing safe, healthy peer and romantic relationships.
• Lower understanding of the importance of obtaining and giving enthusiastic consent prior to sexual activity.
• Less awareness of appropriate/inappropriate touch and lower reporting of child sexual abuse.
• Higher rates of dating violence and intimate partner violence, and less intervention from bystanders.
• Higher rates of homophobia and homophobic bullying.
• Unsafe school environments.
• Lower rates of media literacy.
• Lower rates of social-emotional learning.
• Lower recognition of gender equity, rights, and social justice.

In addition, the lack of access to comprehensive sex education can exacerbate existing health disparities, with disproportionate impacts on specific populations of youth.

Youth who identify as women, youth from communities of color, youth with disabilities, and youth who are LGBTQ2S+ are particularly impacted by inequitable access to comprehensive sex education, as this lack of education can impact their health, safety, and self-identity. Examples of these impacts are outlined below.

A lack of comprehensive sex education can harm young women.

• Female bodies are more prone to STI infection and more likely to experience complications of STI infection than male bodies.
• Female bodies are disproportionately impacted by long-term health consequences of STIs , including pelvic inflammatory disease, infertility, and ectopic pregnancy.
• Female bodies are less likely to have or recognize symptoms of certain STI infections .
• Human papillomavirus (HPV) is the most common STI in young women , and can cause long-term health consequences such as genital warts and cervical cancer.
• Women bear the health and economic effects of unplanned pregnancy.
• Comprehensive sex education addresses these issues by providing medically-accurate, evidence based information on effective strategies to prevent STI infections and unplanned pregnancy.
• Students who identify as female are more likely to experience sexual or physical dating violence than their peers who identify as male. Some of this may be attributed to underreporting by males due to stigma.
• Students who identify as female are bullied on school property more often than students who identify as male.
• Young women ages 16-19 are at higher risk of rape, attempted rape, or sexual assault than the general population.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful gender norms, and building the skills required for respectful, equitable relationships.

A lack of comprehensive sex education can harm youth from communities of color.

• Youth of color benefit from seeing themselves represented in sex education curriculum.
• Sex education programs that use a framing of diversity, equity, rights, and social justice , informed by an understanding of systemic racism and discrimination, have been found to increase positive attitudes around reproductive rights in all students.
• There is a critical need for sex education programs that reflect youth’s cultural values and community .
• Comprehensive sex education can address these needs by developing curriculum that is inclusive of diverse communities, relationships, and cultures, so that youth see themselves represented in their education.
• Racial and ethnic disparities in STI and HIV infection.
• Racial and ethnic disparities in unplanned pregnancy and births among adolescents.
• Nearly half of youth who are Black ages 13-21 report having been pressured into sexual activity .
• Adolescent experience with dating violence is most prevalent among youth who are American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial.
• Adolescents who are Latinx are more likely than their peers who are non-Latinx to report physical dating violence .
• Youth who are Black and Latinx and who experience bullying are more likely to suffer negative impacts on academic performance than their white peers.
• Students who are Asian American and Pacific Islander report bullying and harassment due to race, ethnicity, and language.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful stereotypes, and building the skills required for respectful, equitable relationships.
• Young people of color—specifically those from Black , Asian-American , and Latinx communities– are often hyper-sexualized in popular media, leading to societal perceptions that youth are “older” or more sexually experienced than their white peers.
• Young men of color—specifically those from Black and Latinx communities—are often portrayed as aggressive or criminal in popular media, leading to societal perceptions that youth are dangerous or more sexually aggressive or experienced than white peers.
• These media portrayals can lead to disparities in public perceptions of youth behavior , which can impact school discipline, lost mentorship and leadership opportunities, less access to educational opportunities afforded to white peers, and greater involvement in the juvenile justice system.
• Comprehensive sex education addresses these issues by including positive representations of diverse youth in curriculum, challenging harmful stereotypes, and building the skills required for respectful relationships.

A lack of comprehensive sex education can harm youth with disabilities or special health care needs.

• Youth with disabilities need inclusive, developmentally-appropriate, representative sex education to support their health, identity, and development .
• Youth with special health care needs often initiate romantic relationships and sexual behavior during adolescence, similar to their peers.
• Youth with disabilities and special health care needs benefit from seeing themselves represented in sex education to access the information and skills to build healthy identities and relationships.
• Comprehensive sex education addresses this need by including positive representation of youth with disabilities and special health care needs in curriculum and providing developmentally-appropriate sex education to all youth.
• When youth with disabilities and special health care needs do not get access to the comprehensive sex education that they need, they are at increased risk of sexual abuse or being viewed as a sexual offender.
• Youth with disabilities and special health care needs are more likely than peers without disabilities to report coercive sex, exploitation, and sexual abuse.
• Youth with disabilities and special health care needs report more sexualized behavior and victimization online than their peers without disabilities.
• Youth with disabilities are at greater risk of bullying and have fewer friend relationships than their peers.
• Comprehensive sex education addresses these issues by providing education on healthy relationships, consent, communication, and bodily autonomy.

A lack of comprehensive sex education can harm youth who are LGBTQ2S+.

• Most sex education curriculum is not inclusive or representative of LGBTQ2S+ identities and experiences.
• Because school-based sex education often does not meet their needs, youth who are LGBTQ2S+ are more likely to seek sexual health information online , and thus are more likely to come across misinformation.
• The majority of parents support discussion of sexual orientation in sex education classes.
• Comprehensive sex education addresses these issues by including positive representation of LGBTQ2S+ individuals, romantic relationships, and families.
• Sex education curriculum that overlooks or stigmatizes youth who are LGBTQ2S+ contributes to hostile school environments and harms the healthy sexual and mental development .
• Youth who are LGBTQ2S+ face high levels of discrimination at school and are more likely to miss school because of bullying or victimization .
• Ongoing experiences with stigma, exclusion, and harassment negatively impact the mental health of youth who are LGBTQ2S+.
• Comprehensive sex education provides inclusive curriculum and has been shown to improve understanding of gender diversity, lower rates of homophobia, and reduce homophobic bullying in schools.
• Youth who are LGBTQ2S+ are more likely than their heterosexual peers to report not learning about HIV/STIs in school .
• Lack of education on STI prevention leaves LGBTQ2S+ youth without the information they need to make informed decisions, leading to discrepancies in condom use between LGBTQ2S+ and heterosexual youth.
• Some LGBTQ2S+ populations carry a disproportionate burden of HIV and other STIs: these disparities begin in adolescence , when youth who are LGBTQ2S+ do not receive sex education that is relevant to them.
• Comprehensive sex education provides the knowledge and skills needed to make safe decisions about sexual behavior , including condom use and other forms of STI and HIV prevention.
• Youth who are LBGTQ2S+ or are questioning their sexual identity report higher rates of dating violence than their heterosexual peers.
• Youth who are LGBTQ2S+ or are questioning their sexual identity face higher prevalence of bullying than their heterosexual peers.
• Comprehensive sex education teaches youth healthy relationship and communication skills and is associated with decreases in dating violence and increases in bystander interventions .

A lack of comprehensive sex education can harm youth who are in foster care.

• More than 70% of children in foster care have a documented history of child abuse and or neglect.
• More than 80% of children in foster care have been exposed to significant levels of violence, including domestic violence.
• Youth in foster care are racially diverse, with 23% of youth identifying as Black and 21% of identifying as Latinx, who will have similar experiences as those highlighted in earlier sections of this report.
• Removal is emotionally traumatizing for almost all children. Lack of consistent/stable placement with a responsive, nurturing caregiver can result in poor emotional regulation, impulsivity, and attachment problems.
• Comprehensive sex education addresses these issues by providing evidence-based, culturally appropriate information on healthy relationships, consent, communication, and bodily autonomy.

Sex education is often the first experience that youth have with understanding and discussing their gender and sexual health.

Youth deserve to a strong foundation of developmentally appropriate information about gender and sexuality, and how these things relate to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

Decades of data have demonstrated that comprehensive sex education programs are  effective  in reducing risk of STIs and unplanned pregnancy. These benefits are critical to public health. However, comprehensive sex education goes even further, by instilling youth with a broad range of knowledge and skills that are  proven  to support social-emotional learning, positive communication skills, and development of healthy relationships.

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American Academy of Pediatrics

What is comprehensive sexuality education?

Comprehensive sexuality education  ( CSE ) is a curriculum -based process of teaching and learning about the cognitive, emotional, physical, and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes, and values that will empower them to: realize their health, well-being, and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  pp.16-17.]

Depending on the country or region, CSE may go by other names. It may be referred to as ‘ life skills ’, ‘ family life ’, or ‘ HIV ’ education . It is sometimes called ‘holistic sexuality education’. It is important to confirm with ministries what they use to describe CSE, particularly as context-based terms can inform the most effective approach to take when partnering with and supporting these ministries.

• delivered in formal and non-formal settings , in school or out of school ;
• scientifically accurate , based on research, facts, and evidence;
• incremental , starting at an early age with foundational content and skills, with new information building upon previous learning, using a spiral-curriculum approach that returns to the same topics at a more advanced level each year;
• age- and developmentally appropriate , with content and skills growing in abstractness and explicitness with the age and developmental level of the learners; it also must accommodate developmental diversity, adapting for learners with cognitive and emotional development differences;
• curriculum-based , following a written curriculum that includes key teaching and learning objectives, and the delivery of clear content and skills in a structured way;
• comprehensive , and about much more than just sexual behaviours.

The comprehensive aspect of CSE refers to the breadth, depth, and consistency of topics, as opposed to one-off lessons or interventions. CSE addresses sexual and reproductive health issues, including, but not limited to:

• sexual and reproductive anatomy and physiology;
• puberty and menstruation;
• reproduction, contraception , pregnancy, and childbirth;
• STIs, including HIV and AIDS .

CSE also addresses the psychological, social, and emotional issues relating to these topics, including those that may be challenging in some social and cultural contexts. It supports learners’ empowerment by improving their analytical, communication, and other life skills for health and well-being in relation to:

• human rights,
• a healthy and respectful family life and interpersonal relationships,
• personal and shared values,
• cultural and social norms,
• gender equality,
• non-discrimination,
• sexual behaviour,
• gender-based and other violence,
• consent and bodily integrity,
• sexual abuse and harmful practices such as child , early, and forced marriage, and female genital mutilation/cutting.

Key values of CSE

CSE builds on and promotes universal human rights for all, including children and young people. It emphasizes all persons’ rights to health, education, information equality, and non-discrimination. It raises awareness among young people that they have their own rights, and that they must acknowledge and respect the rights of others, and advocate for those whose rights are violated.

Integrating a gender perspective throughout CSE curricula is integral to effective CSE programmes. CSE analyses how gender norms can influence inequality, and how inequality can affect the overall health and well-being of children and young people, as well as the efforts to prevent issues such as HIV, STIs, early and unintended pregnancies, and gender-based violence . CSE contributes to gender equality by building awareness of the centrality and diversity of gender identities and expressions in people’s lives; examining gender norms shaped by cultural, social and biological differences and similarities; and by encouraging the creation of respectful and equitable relationships based on empathy and understanding.

CSE must be delivered in the context of the range of values, beliefs, and experiences that exist even within a single culture. It enables learners to examine, understand, and challenge the ways in which cultural structures, norms, and behaviours affect their choices and relationships within a variety of settings.

CSE impacts whole cultures and communities, not simply individual learners. It can contribute to the development of a fair and compassionate society by empowering individuals and communities, promoting critical thinking skills, and strengthening young people’s sense of citizenship. It empowers young people to take responsibility for their own decisions and behaviours, and how they may affect others. It builds the skills and attitudes that enable young people to treat others with respect, acceptance, tolerance, and empathy, regardless of their ethnicity, race, social, economic, or immigration status, religion, disability, sexual orientation , gender identity or expression, or sex characteristics.

CSE teaches young people to reflect on the information around them in order to make informed decisions, communicate and negotiate effectively, and develop assertiveness rather than passivity or aggression. These skills foster the creation of respectful and healthy relationships with family members, peers, friends, and romantic or sexual partners.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  pp 16-17.]

‘ Sexuality ’ is defined as ‘a core dimension of being human which includes: the understanding of, and relationship to, the human body; emotional attachment and love; sex; gender; gender identity; sexual orientation; sexual intimacy; pleasure and reproduction. Sexuality is complex and includes biological, social, psychological, spiritual, religious, political, legal, historic, ethical and cultural dimensions that evolve over a lifespan’.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  p.17.]

The word ‘sexuality’ has different meanings in different languages and in different cultural contexts. Taking into account a number of variables and the diversity of meanings in different languages, the following aspects of sexuality need to be considered in the context of CSE:

• Sexuality refers to the individual and social meanings of interpersonal and sexual relationships, in addition to biological aspects. It is a subjective experience and a part of the human need for both intimacy and privacy.
• Simultaneously, sexuality is a social construct, most easily understood within the variability of beliefs, practices, behaviours and identities. ‘Sexuality is shaped at the level of individual practices and cultural values and norms’ (Weeks, 2011).
• Sexuality is linked to power. The ultimate boundary of power is the possibility of controlling one’s own body. CSE can address the relationship between sexuality, gender and power, and its political and social dimensions. This is particularly appropriate for older learners.
• The expectations that govern sexual behaviour differ widely across and within cultures. Certain behaviours are seen as acceptable and desirable, while others are considered unacceptable. This does not mean that these behaviours do not occur, or that they should be excluded from discussion within the context of sexuality education.
• Sexuality is present throughout life, manifesting in different ways and interacting with physical, emotional and cognitive maturation. Education is a major tool for promoting sexual well-being and preparing children and young people for healthy and responsible relationships at the different stages of their lives.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  p. 17.]

When viewed holistically and positively: 

• Sexual health is about well-being, not merely the absence of disease. 
• Sexual health involves respect, safety and freedom from discrimination and violence. 
• Sexual health depends on the fulfilment of certain human rights. 
• Sexual health is relevant throughout the individual’s lifespan, not only to those in the reproductive years, but also to both the young and the elderly. 
• Sexual health is expressed through diverse sexualities and forms of sexual expression. 
• Sexual health is critically influenced by gender norms, roles, expectations and power dynamics.
• Sexual health needs to be understood within specific social, economic and political contexts.
• Characteristics of effective CSE programmes

What is Comprehensive Sexuality Education (CSE)?

“Sexuality” is defined as “a core dimension of being human which includes: the understanding of, and relationship to, the human body; emotional attachment and love; sex; gender; gender identity; sexual orientation; sexual intimacy; pleasure and reproduction. Sexuality is complex and includes biological, social, psychological, spiritual, religious, political, legal, historic, ethical and cultural dimensions that evolve over a lifespan.” (ITGSE, p. 17)

Comprehensive sexuality education (CSE), therefore, is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives. (ITGSE, p. 16)

[World Health Organisation, 2010; Developing sexual health programmes: A framework for action ]

    • Delivered in formal and non-formal settings; whether in-school or out-of-school

    • Scientifically accurate , based on research, facts and evidence

    • Incremental . CSE starts at an early age with foundational content and skills, with new information building upon previous learning, using a spiral-curriculum approach that returns to the same topics at a more advanced level each year.

    • Age- and developmentally-appropriate . CSE content and skills grow in abstractness and explicitness with the age and developmental level of the learners. It also must accommodate developmental diversity, adapting for learners with cognitive and emotional development differences.

    • Curriculum-based . CSE is based in a written curriculum that includes key teaching objectives, learning objectives and the delivery of clear content and skills in a structured way.

    • Comprehensive . CSE is about much more than sexual behaviours. ‘Comprehensive’ refers to the breadth, depth and consistency of topics, as opposed to a one-off lesson or intervention. CSE addresses:

    • sexual and reproductive health issues, including, but not limited to: sexual and reproductive anatomy and physiology;     • puberty and menstruation;     • reproduction, contraception, pregnancy and childbirth;     • STIs, including HIV and AIDS.

CSE also addresses the psychological, social and emotional issues relating to these topics, including those that may be challenging in some social and cultural contexts. It supports learners’ empowerment by improving their analytical, communication and other life skills for health and well-being in relation to:

    • sexuality     • human rights     • a healthy and respectful family life and interpersonal relationships     • personal and shared values     • cultural and social norms     • gender equality     • non-discrimination     • sexual behaviour     • violence and gender-based violence     • consent and bodily integrity     • sexual abuse and harmful practices such as child, early and forced marriage and female genital mutilation/cutting.

Key values of CSE include:     • Human rights approach . CSE builds on and promotes universal human rights for all, including children and young people. It emphasises the rights of all persons to health, education, information equality and non-discrimination. It raises awareness among young people that they have their own rights, and that they must acknowledge and respect the rights of others, and advocate for those whose rights are violated.

    • Gender equality . Integrating a gender perspective throughout CSE curricula is integral to effective CSE programmes. CSE analyses “how gender norms can influence inequality, and how inequality can affect the overall health and well-being of children and young people, as well as the efforts to prevent issues such as HIV, STIs, early and unintended pregnancies, and gender-based violence. CSE contributes to gender equality by building awareness of the centrality and diversity of gender in people’s lives; examining gender norms shaped by cultural, social and biological differences and similarities; and by encouraging the creation of respectful and equitable relationships based on empathy and understanding.”

    • Culturally-relevant and context-appropriate . CSE must be delivered in the context of the range of values, beliefs and experiences that exist even within a single culture. It enables learners to examine, understand and challenge the ways in which cultural structures, norms and behaviours affect their choices and relationships within a variety of settings.

    • Transformative : CSE impacts whole cultures and communities, not simply individual learners. It can contribute to the development of a fair and compassionate society by empowering individuals and communities, promoting critical thinking skills and strengthening young people’s sense of citizenship. It empowers young people to take responsibility for their own decisions and behaviours, and how they may affect others. It builds the skills and attitudes that enable young people to treat others with respect, acceptance, tolerance and empathy, regardless of their ethnicity, race, social, economic or immigration status, religion, disability, sexual orientation, gender identity or expression, or sex characteristics.

    • Develops self-efficacy. CSE teaches young people to reflect on the information around them in order to make informed decisions, communicate and negotiate effectively and develop assertiveness rather than passivity or aggression. These skills foster the creation of respectful and healthy relationships with family members, peers, friends and romantic or sexual partners. (ITGSE, p. 16-17)

[Within the section above a call-out box or pop-up should appear with the following in it:

CSE and the Sustainable Development Goals

The 2030 Agenda and its global Sustainable Development Goals (SDGs) calls for action to leave no one behind, and for the realization of human rights and gender equality for all.” (ITGSE, p. 12). CSE is a part of these goals. The World Health Organisation’s fact sheet, Sexual and Reproductive Health, describes the connections between CSE and SDG 3 (Good Health and Well-Being), SDG 4 (Quality Education), SDG 5 (Gender Equality).]

• Comprehensive sexuality education

Every young person will one day have life-changing decisions to make about their sexual and reproductive health. Yet research shows that the majority of adolescents lack the knowledge required to make those decisions responsibly, leaving them vulnerable to coercion, sexually transmitted infections and unintended pregnancy.

Comprehensive sexuality education enables young people to protect and advocate for their health, well-being and dignity by providing them with a necessary toolkit of knowledge, attitudes and skills. It is a precondition for exercising full bodily autonomy, which requires not only the right to make choices about one’s body but also the information to make these choices in a meaningful way. And because these programmes are based on human rights principles, they advance gender equality and the rights and empowerment of young people. 

UNFPA works with governments to implement comprehensive sexuality education, both in schools and outside of schools through community-based training and outreach. UNFPA also promotes policies for, and investment in, sexuality education programmes that meet internationally agreed upon standards.

What is comprehensive sexuality education?

Key facts about comprehensive sexuality education, what is unfpa doing.

Comprehensive sexuality education is a rights-based and gender-transformative approach, whether in school or outside of school. It is most effective when comprehensive sexuality education is taught over several years by integrating age-appropriate information that accounts for the developing capacities of young people. 

Comprehensive sexuality education includes scientifically accurate information about human development, anatomy and reproductive health, as well as information about contraception, childbirth and sexually transmitted infections (STIs), including HIV.

But it also goes beyond information, helping young people to explore and nurture positive values regarding their sexual and reproductive health and rights. This education includes discussions about family life, relationships, culture and gender roles, and also addresses human rights , gender equality , bodily autonomy and threats such as discrimination, sexual abuse and violence.

Comprehensive sexuality education should recognize the unique needs of learners, especially vulnerable youth groups – such as LGBTQ+ youth, youth living with disabilities, young people in humanitarian settings, young people who use drugs, young people living with HIV, and young transgender people – and should be tailored to reflect their realities.

Taken together, these programmes help young people develop self-esteem and life skills that encourage critical thinking, clear communication, responsible decision-making and respectful and empathetic behaviour.

According to the International Technical Guidance on Sexuality Education , comprehensive sexuality education must be:

• Scientifically accurate
• Incremental 
• Age - and developmentally - appropriate
• Curriculum based 
• Comprehensive 
• Based on a human rights approach
• Based on gender equality 
• Culturally relevant and context appropriate 
• Transformative
• Able to help develop life skills needed to support healthy choices  

8 Key Concepts of Comprehensive Sexuality Education according to the International Technical Guidance on Sexuality Education

This education may go by other names, such as “life skills,” “holistic sexuality education”, “family life,” “healthy lifestyle,” “sex ed”, or “HIV” education. These names may imply differences in emphasis. For example, life skills education may include a focus on caring for sick family members, coping with loss or other similar issues.

No matter what it’s called, comprehensive sexuality education empowers all young people to know, demand and protect their rights. The importance of sexuality education has been recognized by numerous international agreements, including the 2030 Agenda for Sustainable Development and the Political Declaration on HIV and AIDS.

• Comprehensive sexuality education does not lead to earlier sexual activity or riskier sexual behaviour.
• In fact, these programmes reduce risky behaviours: About two thirds of evaluations show reductions in targeted risky behaviours. About 60 per cent of programmes had a positive effect on at least one behavioural or biological outcome, such as increased condom use or reduced unplanned pregnancies.
• Studies of abstinence -only programmes are either inconclusive or show abstinence-only education to be ineffective at improving health outcomes.
• Delivering high-quality comprehensive sexuality education requires training and support.
• Addressing gender and power issues also leads to better health outcomes.
• To be most effective, curricula must be tailored to the specific context and needs of young people.
• Engaging parents and communities as part of this education is critical. Sexuality education is most effective when school-based programmes are complemented by community-based initiatives.

UNFPA works to empower young people to shape the lives they want. That means mitigating adolescents’ risk of developing harmful behaviours, while promoting positive, protective actions and attitudes.

Comprehensive sexuality education is a key component of this strategy. UNFPA works with governments and partners to develop and implement comprehensive sexuality education programmes that meet international technical standards. UNFPA also advocates for policies on, and investments in, comprehensive sexuality education, both in and out of schools. For example, recognizing that traditional sexuality education does not meet the needs of all young people, such as populations outside of school, UNFPA and partners (UNESCO, WHO, UNICEF, UNAIDS) launched the International Technical and Programmatic Guidance on Out-of-School Comprehensive Sexuality Education in 2020 . This guidance provides evidence-based, human rights-centered guidelines and recommendations for reaching the most vulnerable young people. Out-of-school programmes often include community-based training and education, and may target groups such as married adolescent girls, youth engaged with sex work, homeless youth, migrants and refugees, LGBTQ+ youth, youth in remote rural areas, youth living with disabilities, or those living in conflict zones. 

In 2019, UNFPA launched an initiative for out-of-school comprehensive sexuality education specifically targeting frequently left-behind young people. This programme proved timely; it was adapted to continue reaching youth through digital technology during the COVID-19 global pandemic. For example, Latin America and the Caribbean region established a Centre of Excellence with digital training courses based on the out-of-school guidance. In Iran, UNFPA’s mHealth digital platform was adapted to allow young people to communicate with health experts. In Albania, online platforms were able to reach 35,000 young people during school closures.

Many countries have also been expanding the breadth of their curricula in response to UNFPA’s International Technical Guidance on Sexuality Education . In Lao People’s Democratic Republic, a participatory process was used to develop lesson plans and learning objectives after an analysis revealing a lack of gender, rights, sexual behavior and equitable social norms content in the existing Life Skills curricula. In South Africa, the guidance was used to develop lesson plans and training for teachers to empower them to address important sensitive topics that might otherwise be left out of the curriculum. Other examples can be found in The Global Status Report on Comprehensive Sexuality Education . For more information regarding what UNFPA is doing, please contact [email protected] .

Updated 13 September 2021.

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Building an evidence- and rights-based approach to healthy decision-making

As they grow up, young people face important decisions about relationships, sexuality, and sexual behavior. The decisions they make can impact their health and well-being for the rest of their lives. Young people have the right to lead healthy lives, and society has the responsibility to prepare youth by providing them with comprehensive sexual health education that gives them the tools they need to make healthy decisions. But it is not enough for programs to include discussions of abstinence and contraception to help young people avoid unintended pregnancy or disease. Comprehensive sexual health education must do more. It must provide young people with honest, age-appropriate information and skills necessary to help them take personal responsibility for their health and overall well being. This paper provides an overview of research on effective sex education, laws and policies that shape it, and how it can impact young people’s lives.

What is sexual health education?

Sex education is the provision of information about bodily development, sex, sexuality, and relationships, along with skills-building to help young people communicate about and make informed decisions regarding sex and their sexual health. Sex education should occur throughout a student’s grade levels, with information appropriate to students’ development and cultural background. It should include information about puberty and reproduction, abstinence, contraception and condoms, relationships, sexual violence prevention, body image, gender identity and sexual orientation. It should be taught by trained teachers. Sex education should be informed by evidence of what works best to prevent unintended pregnancy and sexually transmitted infections, but it should also respect young people’s right to complete and honest information. Sex education should treat sexual development as a normal, natural part of human development.

Why is sexual health education important to young people’s health and well-being?

Comprehensive sexual health education covers a range of topics throughout the student’s grade levels. Along with parental and community support, it can help young people:

• Avoid negative health consequences. Each year in the United States, about 750,000 teens become pregnant, with up to 82 percent of those pregnancies being unintended.[1,2] Young people ages 15-24 account for 25 percent of all new HIV infections in the U.S.[3] and make up almost one-half of the over 19 million new STD infections Americans acquire each year.4 Sex education teaches young people the skills they need to protect themselves.
• Communicate about sexuality and sexual health. Throughout their lives, people communicate with parents, friends and intimate partners about sexuality. Learning to freely discuss contraception and condoms, as well as activities they are not ready for, protects young people’s health throughout their lives. Delay sexual initiation until they are ready. Comprehensive sexual health education teaches abstinence as the only 100 percent effective method of preventing HIV, STIs, and unintended pregnancy – and as a valid choice which everyone has the right to make. Dozens of sex education programs have been proven effective at helping young people delay sex or have sex less often.[5]
• Understand healthy and unhealthy relationships. Maintaining a healthy relationship requires skills many young people are never taught – like positive communication, conflict management, and negotiating decisions around sexual activity. A lack of these skills can lead to unhealthy and even violent relationships among youth: one in 10 high school students has experienced physical violence from a dating partner in the past year.[6] Sex education should include understanding and identifying healthy and unhealthy relationship patterns; effective ways to communicate relationship needs and manage conflict; and strategies to avoid or end an unhealthy relationship.[7]
• Understand, value, and feel autonomy over their bodies. Comprehensive sexual health education teaches not only the basics of puberty and development, but also instills in young people that they have the right to decide what behaviors they engage in and to say no to unwanted sexual activity. Furthermore, sex education helps young people to examine the forces that contribute to a positive or negative body image.
• Respect others’ right to bodily autonomy. Eight percent of high school students have been forced to have intercourse[8], while one in ten students say they have committed sexual violence.[9] Good sex education teaches young people what constitutes sexual violence, that sexual violence is wrong, and how to find help if they have been assaulted.
• Show dignity and respect for all people, regardless of sexual orientation or gender identity. The past few decades have seen huge steps toward equality for lesbian, gay, bisexual, and transgender (LGBT) individuals. Yet LGBT youth still face discrimination and harassment. Among LGBT students, 82 percent have experienced harassment due to the sexual orientation, and 38 percent have experienced physical harassment.[10]
• Protect their academic success. Student sexual health can affect academic success. The Centers for Disease Control and Prevention (CDC) has found that students who do not engage in health risk behaviors receive higher grades than students who do engage in health risk behaviors. Health-related problems and unintended pregnancy can both contribute to absenteeism and dropout.[11]

What does the research say about effective sex education?

• A 2012 study that examined 66 comprehensive sexual risk reduction programs found them to be an effective public health strategy to reduce adolescent pregnancy, HIV, and STIs.[12]
• Research from the National Survey of Family Growth assessed the impact of sexuality education on youth sexual risk-taking for young people ages 15-19 and found that teens who received comprehensive sex education were 50 percent less likely to experience pregnancy than those who received abstinence-only-until-marriage programs.[13]
• Even accounting for differences in household income and education, states which teach sex education and/or HIV education that covers abstinence as well as contraception, tend to have the lowest pregnancy rates.[14]
• National Sexuality Education Standards provide a roadmap. The National Sexuality Education Standards, developed by experts in the public health and sexuality education field and heavily influenced by the National Health Education Standards, provide guidance about the minimum essential content and skills needed to help students make informed decisions about sexual health.15 The standards focus on seven topics as the minimum, essential content and skills for K–12 education: Anatomy and Physiology, Puberty and Adolescent Development, Identity, Pregnancy and Reproduction, Sexually Transmitted Diseases and HIV, Healthy Relationships, and Personal Safety. Topics are presented using performance indicators—what students should learn by the end of grades 2, 5, 8, and 12.[16] Schools which are developing comprehensive sexual health education programs should consult the National Sexuality Education Standards to provide students with the information and skills they need to develop into healthy adults.
• 16 programs demonstrated a statistically significant delay in the timing of first sex.
• 21 programs showed statistically significant declines in teen pregnancy, HIV or other STIs.
• 16 programs helped sexually active youth to increase their use of condoms.
• 9 programs demonstrated success at increasing use of contraception other than condoms.
• 40 percent delayed sexual initiation, reduced number of sexual partners, or increased condom or contraceptive use;
• 30 percent reduced the frequency of sex, including return to abstinence; and
• 60 percent reduced unprotected sex.[17]
• The Office of Adolescent Health, a division of the U.S. Department of Health and Human Services, keeps a list of evidence-based interventions, with ratings based on the rigor of program impact studies and strength of the evidence supporting 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 reducing rates of associated sexual risk behaviors (defined by sexual activity, contraceptive use, or number of partners).[18]

What’s wrong with abstinence-only-until-marriage programs?

Many students receive abstinence-only-until marriage programs instead of or in addition to more comprehensive programs. These programs:

• Depict abstinence until heterosexual marriage as the only moral choice for young people
• Mention contraception only in terms of failure rates
• Focus on heterosexual youth, ignoring the needs of LGBTQ youth
• Often use outdated gender roles, urging “modesty” for all girls while painting all boys as sexual aggressors.
• Have been found to contain false information
• Are not supported by the majority of Americans.[19]

Only one abstinence-only program has ever been proven effective at helping young people delay sex; yet in withholding information about contraception, it leaves those who do have sex completely at risk. Studies show that 99 percent of people will use contraception in their lifetimes,[20] and that the provision of information about contraception does not hasten the onset of sexual debut or increase sexual activity.[10] Meanwhile, thirty years of public health research clearly demonstrate that comprehensive sex education can help young people delay sexual initiation while also assisting them to use protection when they do become sexually active. We want young people to behave responsibly when it comes to decisions about sexual health, and that means society has the responsibility to provide them with honest, age-appropriate comprehensive sexual health education; access to services to prevent pregnancy and sexually transmitted infections; and the resources to help them lead healthy lives.

All young people need comprehensive sexual health education, while others also need sexual health services. Youth at disproportionate risk for sexual health disparities may also need targeted interventions designed specifically to build self efficacy and agency. Further, administrators and other policy makers must recognize that structural determinants, socio-cultural factors and cultural norms have been shown to have a strong impact on youth sexual health and must be tackled to truly redress sexual health disparity fueled by social inequity.

How is the content of a student’s sex education decided?

Many factors help shape the content of a student’s sex education. These include:

• State and federal funding the school district receives
• State laws and standards regarding sex education
• School district level policies and/or standards regarding curricula and content
• The program or curriculum a district or individual school selects
• The individual(s) who delivers the program.

With thousands of school districts around the nation, students’ experiences can vary drastically from district to district and school to school.

What are federal, state, and local structures that affect sex education?

In the United States, education is largely a state and local responsibility, as dictated by the 10th Amendment of the U.S. Constitution. This amendment states that “the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”[3] Because the Constitution doesn’t specifically mention education, the federal government does not have any direct authority regarding curriculum, instruction, administration, personnel, etc. In 1980, the U.S. Department of Education was created. While this move centralized federal efforts and responsibilities into one office, it did not come with an increase in federal jurisdiction over the educational system.

The U.S. Department of Education currently has no authority over sexual health education. However, there have been federal funds allocated, primarily through the Department of Health and Human Services that school systems and community-based agencies have used throughout the last three decades to provide various forms of sex education.[21]

• Federal funding: Until FY2010, there was no designated funding for a comprehensive approach to sex education. In 1982, federal support of abstinence-only programs began, and in 1996, expanded drastically. From 1996-2010, over $1.5 billion in federal funding went to abstinence-only programs, which were conducted with little oversight and were proven ineffective. While one large stream of funding for abstinence-only programs was cancelled in 2010, at publication one still exists (as authorized by Congress through Title V funding) and is funded at $50 million per year.[22]

In 2010, two streams of funding became available for evidence-based sex education interventions.[22]

• PREP: The Personal Responsibility Education Program (PREP) was authorized by Congress as a part of the Affordable Care Act of 2010. PREP provides grants ($75 million over five years) for programs which teach about both abstinence and contraception in order to help young people reduce their risk for unintended pregnancy, HIV, and STIs. In Fiscal Year 2012, 45 states applied for PREP. PREP grants are issued to states, typically the state health departments. All programs implemented with PREP funding are to educate adolescents about both abstinence and contraception for the prevention of pregnancy and STIs, including HIV/AIDS, and must cover at least three adulthood preparation subjects such as healthy relationships, adolescent development, financial literacy, educational and career success, and healthy life skills.
• The President’s Teen Pregnancy Prevention Initiative (TPPI) funds medically-accurate and age-appropriate programs to reduce teen pregnancy. Seventy-five grantees in 32 states received TPPI funds in FY 2012. TPPI grants are distributed by the Office of Adolescent Health to local public and private entities. Grantees must implement an evidence-based program which has been proven effective at preventing teen pregnancy. According to OAH, 31 programs meet these criteria, including one abstinence-only-until-marriage program.
• States may accept PREP, TPPI, or Title V funds. Many states accept funds for both abstinence-only programs and evidence-based interventions. In 2013, 19 SEAs and 17 LEA received five year cooperative agreements from CDC/DASH to implement ESHE within their school systems.

In addition, in 2013, CDC/Division of School Health issued a request for proposals to fund State Education Agencies (SEAs) and Large Municipal Education Agencies (LEAs) to implement Exemplary Sexual Health Education (ESHE). ESHE is defined as a systematic, evidence-informed approach to sexual health education that includes the use of grade-specific, evidence-based interventions, but also emphasizes sequential learning across elementary, middle, and high school grade levels.[23]

States may accept PREP, TPPI, or Title V funds. Many states accept funds for both abstinence-only programs and evidence-based interventions. In 2013, 19 SEAs and 17 LEAs received five year cooperative agreements from CDC/DASH to implement ESHE within their school systems.[22]

• The Real Education for Healthy Youth Act: While there is as yet no law that supports comprehensive sexual health education, there is pending legislation. The Real Education for Healthy Youth Act (S. 372/H.R. 725), introduced in February 2013 by the late Senator Frank Lautenberg (D-NJ) and Representative Barbara Lee (D-CA), would ensure that federal funding is allocated to comprehensive sexual health education programs that provide young people with the skills and information they need to make informed, responsible, and healthy decisions. This legislation sets forth a vision for comprehensive sexual health education programs in the United States.
• 30 states have no law that governs sex education, and schools are not required to provide it
• 25 states mandate that sex education, if taught, must include abstinence, but do not require it to include contraception.
• Six states mandate that sex education include either a ban on discussing homosexuality, or material about homosexuality that is overtly discriminatory.[22]

Each state has a department of education headed by a chief state school officer, more commonly known as the Superintendent of Public Instruction or the Commissioner of Education (titles vary by state). State departments of education are generally responsible for disbursing state and federal funds to local school districts, setting parameters for the length of school day and year, teacher certification, testing requirements, graduation requirements, developing learning standards and promoting professional development. Generally, the chief state school officer is appointed by the Governor, though in a few states they are elected.[23]

State departments of education may also have Standards which provide benchmark measures that define what students should know and be able to do at specified grade levels. These sometimes, but not always, address sexual health education. For instance, Connecticut and New Jersey have standards similar to the National Sexuality Education Standards in place and which address reproduction, prevention of STIs and pregnancy, and healthy relationships. A number of other states have general health education standards which do not directly address sexual health, while others make mention of HIV/STI prevention and abstinence but don’t demand the most thorough instruction in sexual health.[24]

• Local Policy: At the school district level, Pre-K-12 public schools are generally governed by local school boards (with the exception of Hawaii which does not have any local school board system). Local school boards are typically comprised of 5 to 7 members who are either elected by the public or appointed by other government officials.[21]

Local school boards are responsible for ensuring that each school in their district is in compliance with the laws and policies set by the state and federal government. Local school board also have broad decision and rule-making authority with regards to the operations of their local school district, including determining the school district budget and priorities; curriculum decisions such as the scope and sequence of classroom content in all subject areas; and textbook approval authority. [21]

Typically, school boards set the sex education policy for a school district. They must follow state law. Some school boards provide guidelines or standards, while others select specific curricula for schools to deliver. Most school boards are advised by School Health Advisory Councils (SHACs). SHAC members are individuals who represent the community and who provide advice about health education.[21]

How can I work for comprehensive sexual health education for students in my community?

There are a number of ways to help ensure that students get the information they need to live healthy lives, build healthy relationships, and take personal responsibility for their health and well being.

• Urge your Members of Congress to support the Real Education for Healthy Youth Act, in person, by phone, or online.
• Contact your school board and urge them to adopt the National Sexuality Education Standards and require comprehensive sexual health programs.
• Join a School Health Advisory Council in your area – both young people and adults are eligible to serve on most.
• Organize within your community – a group of individuals, or a coalition of like-minded organizations – to do one or all of the above.

Young people have the right to lead healthy lives. As they develop, we want them to take more and more control of their lives so that as they get older, they can make important life decisions on their own. The balance between responsibility and rights is critical because it sets behavioral expectations and builds trust while providing young people with the knowledge, ability, and comfort to manage their sexual health throughout life in a thoughtful, empowered and responsible way. But responsibility is a two-way street. Society needs to provide young people with honest, age-appropriate information they need to live healthy lives, and build healthy relationships, and young people need to take personal responsibility for their health and well being. Advocates must also work to dismantle barriers to sexual health, including poverty and lack of access to health care.

Emily Bridges, MLS, and Debra Hauser, MPH

Advocates for Youth © May 2014

1. CDC. Youth Risk Behavior Surveillance, 2011. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.

2. Finer LB et al., Disparities in rates of unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.

3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2011. Atlanta: U.S. Department of Health and Human Services; 2012.

4. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012. Atlanta: U.S. Department of Health and Human Services; 2013.

5. Alford S, et al. Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. 2nd ed. Washington, DC: Advocates for Youth, 2008;

6. Dating Matters: Strategies to Promote Health Teen Relationships. Atlanta: Center for Disease Control and Prevention; 2013.

7. National Sexual Education Standards: Core Content and Skills, K-12. A Special Publication of the Journal of School Health. 2012: 6-9. http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf. Accessed October 2, 2013.

8. Davis A. Interpersonal and Physical Dating Violence among Teens. National Council on Crime and Delinquency, 2008. Retrieved November 15, 2013 from http://www.nccdglobal.org/sites/default/files/publication_pdf/focus-dating-violence.pdf

9. Ybarra ML and Mitchell KJ. “Prevalence Rates of Male and Female Sexual Violence Perpetrators in a National Sample of Adolescents.” JAMA Pediatrics, December 2013.

10. Gay, Lesbian, and Straight Education Network. The 20011 National School Climate Survey: The School Related Experiences of Our Nation’s Lesbian, Gay, Bisexual and Transgender Youth. New York, NY: GLSEN, 2012.

11. CDC. Sexual Risk Behaviors and Academic Achievement. Atlanta, GA: CDC, (2010); http://www.cdc.gov/HealthyYouth/ health_and_academics/pdf/sexual_risk_behaviors.pdf; last accessed 5/23/2010. 12. Chin B et al. “The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.” American Journal of Preventive Medicine, March 2012.

13. Kohler PK, Manhart LE, Lafferty WE. Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy. Journal of Adolescent Health. 2007; 42(4): 344-351.

14. Stanger-Hall KF, Hall DW. “Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

15. National Sexual Education Standards: Core Content and Skills, K-12. A Special Publication of the Journal of School Health. 2012: 6-9. http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf. Accessed October 2, 2013.

16. National Sexual Education Standards: Core Content and Skills, K-12. A Special Publication of the Journal of School Health. 2012: 6-9. http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf. Accessed October 2, 2013.

17. Kirby D. Emerging Answers 2007. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007. 18. Office of Adolescent Health. “Evidence-Based Programs (31 Programs). Accessed March 5, 2014 from http://www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/db/programs.html

19. Public Religion Research Institute. Survey – Committed to Availability, Conflicted about Morality: What the Millennial Generation Tells Us about the Future of the Abortion Debate and the Culture Wars. 2011. Accessed from http://publicreligion.org/research/2011/06/committed-to-availability-conflicted-about-morality-what-the-millennial-generation-tells-us-about-the-future-of-the-abortion-debate-and-the-culture-wars/ on May 13, 2014.

20. Daniels K, Mosher WD and Jones J, Contraceptive methods women have ever used: United States, 1982–2010,National Health Statistics Reports, 2013, No. 62, <http://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf>, accessed Mar. 20, 2013.

21. Future of Sex Education. “Public Education Primer. “ Accessed from http://www.futureofsexed.org/documents/public_education_primer.pdf on May 13, 2014.

22. Sexuality Information and Education Council of the United States, Siecus State Profiles, Fiscal Year 2012. Accessed from http://www.siecus.org/index.cfm?fuseaction=Page.ViewPage&PageID=1369 on May 13, 2014.

23. Centers for Disease Control and Prevention. “In Brief: Rationale for Exemplary Sexual Health Education (ESHE) for PS13-1308. Accessed from http://www.cdc.gov/healthyyouth/fundedpartners/1308/strategies/education.htm on May 13, 2014.

24. Answer. “State sex education policies by state.” Accessed from http://answer.rutgers.edu/page/state_policy/ on May 13, 2014.

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The world is changing, and changing fast, what with emerging technologies, environmental uncertainty and shifting global demographics. Young people leaving school or university today are facing a very different set of challenges to those experienced by previous generations.                         

A good quality education is paramount. It is indispensable in a world marked by complexity and uncertainty. This includes inclusive and equitable education and lifelong learning opportunities for all, the ambition of Sustainable Development Goal 4. This is a fundamental human right, and one of the most powerful tools for achieving sustainable development.

What a well-rounded education should include

Yet, when we talk about a good education, we must also go beyond the traditional academic focus. We must look to education that supports young people to develop the knowledge, skills, ethical values and attitudes they need to make conscious, healthy and respectful choices about relationships, sex and reproduction.

Comprehensive sexuality education is not just about reproduction, family planning and safe sexual behaviors. It also includes positive aspects of sexuality, such as love and relationships based on mutual respect and equality. It includes discussions about values, rights, culture and gender, about power dynamics based on race, gender, ability or sexuality and how to recognize, challenge and change harmful gender norms. 

The research behind comprehensive sexuality education

UNESCO commissioned two evidence-based reviews around comprehensive sexuality education, in 2008 and 2016, and the facts are now clear. Curriculum-based sexuality education programs do not increase sexual activity, sexual risk-taking behaviors or STI/HIV infection rates. Instead, comprehensive sexuality education increases young people’s knowledge and understanding of sexual and reproductive health, can delay sexual initiation and leads to safer sexual behavior.

The evidence tells us that comprehensive sexuality education also empowers young people to question their social context and challenge negative social norms, including gender norms, and to be part of broader societal efforts towards gender equality.

However, despite the evidence, millions of young people around the world are still making the transition from childhood to adulthood receiving inaccurate, incomplete and judgement-laden information around their physical, social and emotional development.

Moreover, without access to good quality comprehensive sexuality education, we cannot achieve the Sustainable Development Goals we have set for 2030. How can we expand education opportunities if we are not able to improve sexual and reproductive health-related outcomes, such as reducing HIV infection and adolescent pregnancy rates? How can we reduce or prevent gender-based violence and create safe and inclusive learning environments, if we are unable to disrupt harmful gender norms?

A new report: Facing the facts

UNESCO has presented the latest evidence at this year’s Women Deliver Conference 2019 , as part of a new report, produced with the Global Education Monitoring Report. The report, Facing the facts: the case for comprehensive sexuality education argues that comprehensive sexuality education is part of the delivery of a quality education. It shows how governments can overcome social resistance and operational constraints to scale up these programs as part of their commitment to SDG 4.

It tells us that one of the main barriers to comprehensive sexuality education is negative and misinformed public attitudes. These could be concerns that this type of education is at odds with local cultural or religious beliefs around sexuality, or that it is inappropriate for young children.

There are also operational constraints. Even in countries with an enabling policy environment, implementation can be thwarted by a lack of teacher preparation and support, a lack of appropriate learning materials, and a lack of planning, financing and monitoring.

Engaging all stakeholders

At UNESCO, our comprehensive sexuality education programming is a key pillar of efforts to strengthen the delivery of quality education for all. We have developed a suite of resources to assist governments in strengthening policy frameworks to ensure comprehensive sexuality education in schools, as well as advocacy tools for civil society partners, parents and teachers to use to assist governments in fulfilling this right.

Our activities in this area need to reach beyond ministers and decision-makers, to ensure teachers receive sufficient training, and guidance to deliver the content of comprehensive sexuality education. Together, we must commit to strong political leadership, invest in teacher education, and improve curricula.

Comprehensive sexuality education is an essential part of a good quality education that helps prepare young people for a fulfilling life in a changing world. It improves sexual and reproductive health outcomes, promotes safe and gender equitable learning environments, and improves education access and achievement.

Access more resources:

• Report - Facing the facts: the case for comprehensive sexuality education
• UNESCO’s work in comprehensive sexuality education

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The State of Sex Education in the United States

Kelli stidham hall.

Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia

Jessica McDermott Sales

Kelli a. komro, john santelli.

Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York

For more than four decades, sex education has been a critically important but contentious public health and policy issue in the United States [ 1 – 5 ]. Rising concern about nonmarital adolescent pregnancy beginning in the 1960s and the pandemic of HIV/AIDS after 1981 shaped the need for and acceptance of formal instruction for adolescents on life-saving topics such as contraception, condoms, and sexually transmitted infections. With widespread implementation of school and community-based programs in the late 1980s and early 1990s, adolescents’ receipt of sex education improved greatly between 1988 and 1995 [ 6 ]. In the late 1990s, as part of the “welfare reform,” abstinence only until marriage (AOUM) sex education was adopted by the U.S. government as a singular approach to adolescent sexual and reproductive health [ 7 , 8 ]. AOUM was funded within a variety of domestic and foreign aid programs, with 49 of 50 states accepting federal funds to promote AOUM in the classroom [ 7 , 8 ]. Since then, rigorous research has documented both the lack of efficacy of AOUM in delaying sexual initiation, reducing sexual risk behaviors, or improving reproductive health outcomes and the effectiveness of comprehensive sex education in increasing condom and contraceptive use and decreasing pregnancy rates [ 7 – 12 ]. Today, despite great advancements in the science, implementation of a truly modern, equitable, evidence-based model of comprehensive sex education remains precluded by sociocultural, political, and systems barriers operating in profound ways across multiple levels of adolescents’ environments [ 4 , 7 , 8 , 12 – 14 ].

At the federal level, the U.S. congress has continued to substantially fund AOUM, and in FY 2016, funding was increased to $85 million per year [ 3 ]. This budget was approved despite President Obama’s attempts to end the program after 10 years of opposition and concern from medical and public health professionals, sexuality educators, and the human rights community that AOUM withholds information about condoms and contraception, promotes religious ideologies and gender stereotypes, and stigmatizes adolescents with nonheteronormative sexual identities [ 7 – 9 , 11 – 13 ]. Other federal funding priorities have moved positively toward more medically accurate and evidence-based programs, including teen pregnancy prevention programs [ 1 , 3 , 12 ]. These programs, although an improvement from AOUM, are not without their challenges though, as they currently operate within a relatively narrow, restrictive scope of “evidence” [ 12 ].

At the state level, individual states, districts, and school boards determine implementation of federal policies and funds. Limited in-class time and resources leave schools to prioritize sex education in competition with academic subjects and other important health topics such as substance use, bullying, and suicide [ 4 , 13 , 14 ]. Without cohesive or consistent implementation processes, a highly diverse “patchwork” of sex education laws and practices exists [ 4 ]. A recent report by the Guttmacher Institute noted that although 37 states require abstinence information be provided (25 that it be stressed), only 33 and 18 require HIV and contraceptive information, respectively [ 1 ]. Regarding content, quality, and inclusivity, 13 states mandate instruction be medically accurate, 26 that it be age appropriate, eight that it not be race/ethnicity or gender bias, eight that it be inclusive of sexual orientation, and two that it not promote religion [ 1 ]. The Centers for Disease Control and Prevention’s 2014 School Health Policies and Practices Study found that high school courses require, on average, 6.2 total hours of instruction on human sexuality, with 4 hours or less on HIV, other sexually transmitted infections (STIs), and pregnancy prevention [ 15 ]. Moreover, 69% of high schools notify parents/guardians before students receive such instruction; 87% allow parents/guardians to exclude their children from it [ 15 ]. Without coordinated plans for implementation, credible guidelines, standards, or curricula, appropriate resources, supportive environments, teacher training, and accountability, it is no wonder that state practices are so disparate [ 4 ].

At the societal level, deeply rooted cultural and religious norms around adolescent sexuality have shaped federal and state policies and practices, driving restrictions on comprehensive sexual and reproductive health information, and service delivery in schools and elsewhere [ 12 , 13 ]. Continued public and political debates on the morality of sex outside marriage perpetuate barriers at multiple levels—by misguiding state funding decisions, molding parents’ (mis)understanding of programs, facilitating adolescents’ uptake of biased and inaccurate information in the classroom, and/or preventing their participation in sex education altogether [ 4 , 7 , 8 , 12 – 14 ].

Trends in Adolescents’ Receipt of Sex Education

In this month’s Journal of Adolescent Health , Lindberg et al. [ 16 ] provide further insight into the current state of sex education and the implications of federal and state policies for adolescents in the United States. Using population data from the National Survey of Family Growth, they find reductions in U.S. adolescents’ receipt of formal sex education from schools and other community institutions between 2006–2010 and 2011–2013. These declines continue previous trends from 1995–2002 to 2006–2008, which included increases in receipt of abstinence information and decreases in receipt of birth control information [ 17 – 19 ]. Moreover, the study highlights several additional new concerns. First, important inequities have emerged, the most significant of which are greater declines among girls than boys, rural-urban disparities, declines concentrated among white girls, and low rates among poor adolescents. Second, critical gaps exist in the types of information (practical types on “where to get birth control” and “how to use condoms” were lowest) and the mistiming of information (most adolescents received instruction after sexual debut) received. Finally, although receipt of sex education from parents appears to be stable, rates are low, such that parental-provided information cannot be adequately compensating for gaps in formal instruction.

Paradoxically, the declines in formal sex education from 2006 to 2013 have coincided with sizeable declines in adolescent birth rates and improved rates of contraceptive method use in the United States from 2007 to 2014 [ 20 , 21 ]. These coincident trends suggest that adolescents are receiving information about birth control and condoms elsewhere. Although the National Survey of Family Growth does not provide data on Internet use, Lindberg et al. [ 16 ] suggest that it is likely an important new venue for sex education. Others have commented on the myriad of online sexual and reproductive resources available to adolescents and their increasing use of sites such as Bedsider.org, StayTeen.org, and Scarleteen. [ 2 , 14 , 22 – 24 ].

The Future of Sex Education

Given the insufficient state of sex education in the United States in 2016, existing gaps are opportunities for more ambitious, forward-thinking strategies that cross-cut levels to translate an expanded evidence base into best practices and policies. Clearly, digital and social media are already playing critical roles at the societal level and can serve as platforms for disseminating innovative, scientifically and medically sound models of sex education to diverse groups of adolescents, including sexual minority adolescents [ 14 , 22 – 24 ]. Research, program, and policy efforts are urgently needed to identify effective ways to harness media within classroom, clinic, family household, and community contexts to reach the range of key stakeholders [ 13 , 14 , 22 – 24 ]. As adolescents turn increasingly to the Internet for their sex education, perhaps school-based settings can better serve other unmet needs, such as for comprehensive sexual and reproductive health care, including the full range of contraceptive methods and STI testing and treatment services. [ 15 , 25 ].

At the policy level, President Obama’s budget for FY 2017 reflects a strong commitment to supporting youths’ access to age-appropriate, medically accurate sexual health information, with proposed elimination of AOUM and increased investments in more comprehensive programs [ 3 ]. Whether these priorities will survive an election year and new administration is uncertain. It will also be important to monitor the impact of other health policies, particularly regarding contraception and abortion, which have direct and indirect implications for minors’ rights and access to sexual and reproductive health information and care [ 26 ].

At the state and local program level, models of sex education that are grounded in a broader interdisciplinary body of evidence are warranted [ 4 , 11 – 14 , 27 – 29 ]. The most exciting studies have found programs with rights-based content, positive, youth-centered messages, and use of interactive, participatory learning and skill building are effective in empowering adolescents with the knowledge and tools required for healthy sexual decision-making and behaviors [ 4 , 11 – 14 , 27 – 29 ]. Modern implementation strategies must use complementary modes of communication and delivery, including peers, digital and social media, and gaming, to fully engage young people [ 14 , 22 , 23 , 27 ].

Ultimately, expanded, integrated, multilevel approaches that reach beyond the classroom and capitalize on cutting-edge, youth-friendly technologies are warranted to shift cultural paradigms of sexual health, advance the state of sex education, and improve sexual and reproductive health outcomes for adolescents in the United States.

Acknowledgments

Funding Sources

K.S.H. is supported by the National Institute of Child Health and Human Development #1K01HD080722-01A1.

Contributor Information

Kelli Stidham Hall, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Jessica McDermott Sales, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Kelli A. Komro, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.

John Santelli, Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York.

Sex Education that Goes Beyond Sex

• Posted November 28, 2018
• By Grace Tatter

Historically, the measure of a good sex education program has been in the numbers: marked decreases in the rates of sexually transmitted diseases, teen pregnancies, and pregnancy-related drop-outs. But, increasingly, researchers, educators, and advocates are emphasizing that sex ed should focus on more than physical health. Sex education, they say, should also be about relationships.

Giving students a foundation in relationship-building and centering the notion of care for others can enhance wellbeing and pave the way for healthy intimacy in the future, experts say. It can prevent or counter gender stereotyping and bias. And it could minimize instances of sexual harassment and assault in middle and high school — instances that may range from cyberbullying and stalking to unwanted touching and nonconsensual sex. A recent study from Columbia University's Sexual Health Initative to Foster Transformation (SHIFT) project suggests that comprehensive sex education protects students from sexual assault even after high school.

If students become more well-practiced in thinking about caring for one another, they’ll be less likely to commit — and be less vulnerable to — sexual violence, according to this new approach to sex ed. And they’ll be better prepared to engage in and support one another in relationships, romantic and otherwise, going forward. 

Giving students a foundation in relationship-building can enhance wellbeing and pave the way for healthy intimacy in the future, experts say. It can also prevent or counter gender stereotyping, and it could minimize instances of sexual harassment and assault in middle and high school.

Introducing Ethics Into Sex Ed

Diving into a conversation even tangentially related to sex with a group of 20 or so high school students isn’t easy. Renee Randazzo helped researcher Sharon Lamb pilot the Sexual Ethics and Caring Curriculum while a graduate student at the University of Massachusetts Boston. She recalls boys snickering during discussions about pornography and objectification. At first, it was hard for students to be vulnerable.

But the idea behind the curriculum is that tough conversations are worth having. Simply teaching students how to ask for consent isn’t enough, says Lamb, a professor of counseling psychology at UMass Boston, who has been researching the intersection between caring relationships, sex, and education for decades. Students also to have understand why consent is important and think about consent in a variety of contexts. At the heart of that understanding are questions about human morality, how we relate to one another, and what we owe to one another. In other words, ethics.

“When I looked at what sex ed was doing, it wasn’t only a problem that kids weren’t getting the right facts,” Lamb says. “It was a problem that they weren’t getting the sex education that would make them treat others in a caring and just way.”

She became aware that when schools were talking about consent — if they were at all — it was in terms of self-protection. The message was: Get consent so you don’t get in trouble.

But there’s more at play, Lamb insists. Students should also understand the concept of mutuality — making decisions with a partner and understanding and addressing other people’s concerns or wishes — and spend time developing their own sense of right and wrong. 

“If a young person is not in a healthy relationship, they can’t negotiate sex in a meaningful way. Even if they’re not having sex yet, they’re grappling with the idea of what a healthy relationship is.”

The curriculum she developed invites students to engage in frank discussions about topics like objectification in the media and sexting. If a woman is shamed for being in a sexy video, but she consented to it, does she deserve the criticism? Regardless of what you think, can you justify your position?

“How do they want to treat people, what kind of partner do they want to be? That takes discussion,” Lamb says. “It’s not a skill-training thing.”

The idea behind the curriculum isn’t that anything goes, so long as students can discuss their reasoning. Instead, the goal is that students develop the critical-reasoning skills to do the right thing in tricky situations. 

After Randazzo’s students got over their cases of the giggles, the conversations were eye-opening, she says. “You give them the opportunity unpack their ideas and form their own opinions,” she says.

Healthy Relationships — and Prevention

Most sexual assault and violence in schools is committed by people who know their victims — they’re either dating, friends, or classmates. Regardless, they have a relationship of some sort, which is why a focus on relationships and empathy is crucial to reducing violence and preparing students for more meaningful lives.

And while it might seem uncomfortable to move beyond the cut-and-dried facts of contraception into the murkier waters of relationships, students are hungry for it. A survey by researchers at the Harvard Graduate School of Education's  Making Caring Common  initiative found that 65 percent of young-adult respondents wished they had talked about relationships at school.

“It’s so critical that kids are able to undertake this work of learning to love somebody else,” says developmental psychologist Richard Weissbourd , the director of Making Caring Common and lead author of a groundbreaking report called The Talk: How Adults Can Promote Young People’s Healthy Relationships and Prevent Misogyny and Sexual Harassment . “They’re not going to be able to do it unless we get them on the road and are willing to engage in thoughtful conversations.”

Nicole Daley works with OneLove , a nonprofit focused on teen violence prevention. She previously worked extensively with Boston Public Schools on violence prevention. She echoes Lamb and Weissbourd: A focus on relationships is key to keeping students safe.

“If a young person is not in a healthy relationship, they can’t negotiate sex in a meaningful way,” she says. “Really discussing healthy relationships and building that foundation is important. Even if they’re not having sex yet, they’re grappling with the idea of what healthy relationship is.”

And it’s critical to start that work before college.

Shael Norris spent the first two decades of her career focusing on college campuses, but now is focused on younger students with her work through Safe BAE . By college, many people’s ideas about how to act when it comes to sex or romance are entrenched, she says. The earlier young people can start interrogating what they know about sex and relationships, the better.

Safe BAE is led by Norris and young survivors of sexual assault. The organization works to educate students about healthy relationships, sexual violence, students’ rights under Title IX, and other related topics.

Movement to change middle and high school curricula to include a focus on healthy relationships and consent has been slow, Norris notes. In 2015, Senators Tim Kaine (D-Va.) and Claire McCaskill (D-Mo.) introduced the Teach Safe Relationships Act, which would have mandated secondary schools teach about safe relationships, including asking for consent, in health education courses. It didn’t go anywhere. And while eight states now mandate some sort of sexual consent education , there’s no consensus about what that should entail.

Instead, the momentum for a more comprehensive sexual education that considers relationships and violence prevention is coming from individual teachers, students and parents.

“We don’t have to wait for politicians to start having conversations about this,” Norris says.

A New Approach to Sex Ed

• Develop an ethical approach to sex ed. Place emphasis on helping students learn how to care for and support one another. This will reduce the chance they’ll commit, or be vulnerable to, sexual violence.
• Don’t just tell students how to ask for consent; prompt them to consider why concepts like consent are important. It’s not just about staying out of legal trouble — it’s also about respecting and caring for others.
• Respect students’ intelligence and engage them in discussions about who they want to be as people. Serious dialogue about complicated topics will hone their critical-thinking skills and help them be prepared to do the right thing.
• Even without access to a curriculum, students, parents and educators can work together to facilitate conversations around sexual violence prevention through clubs, with help from organizations like Safe BAE.

Additional Resource

• National Sexuality Education Standards: Core Content and Skills, K–12

Part of a special series about preventing sexual harassment at school.  Read the whole series .

Illustration by Wilhelmina Peragine

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The State of Sex Education

Power to Decide

Why sex education matters.

Maggi LeDuc

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In 2014, a study found that 93% of parents supported having sex education in middle school and 96% supported teaching sex ed in high school. A 2017 study again found that 93% of parents favored sexuality education in schools. These are not isolated results; decades of research support the benefits of comprehensive, inclusive sex education.

Comprehensive sexuality education is also supported by professional organizations such as the American Medical Association, the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, and the 184 organizations—including Power to Decide—who joined in coalition in May 2020 to support the Sex Ed for All movement. 

At the moment, 28 states (and DC) require some kind of sex education and HIV education and seven states only require HIV education. However, only 17 require that education to be medically accurate and 29 states require schools to stress abstinence . Because sex education in schools is legislated on the state (or individual school district) level, not the federal, the quality of what is taught varies widely across the country. The CDC’s 2018 School Health Profiles found that only 43% of high schools and 18% of middle schools taught ‘key’ topics in sex education. Some of the topics the CDC labels as ‘key’ include information on how to prevent STIs and unplanned pregnancy, maintaining healthy relationships, avoiding peer pressure, and using appropriate health services. 

The World Health Organization notes that the focus of sexuality education in Europe has shifted from preventing pregnancy in the 1960’s to preventing HIV in the ‘80’s to today covering these topics alongside such issues as sexism, homophobia, and online bullying gender norms, the sexuality spectrum, and emotional development. In contrast, a 2018 study reported that students in the US were less likely to receive sex education on key topics in 2015-2019 than they were in 1995. The same study found that only 43% of females and 47% of males who had penis-in-vagina sex covered safe sex in school before they engaged in sex for the first time. 

Truly comprehensive sex education includes, but isn't limited to:

• Taught by trained sex educators. 
• Begun early and progresses at an age-appropriate pace. 
• Evidence-based. 
• Inclusive of LGBTQ young people.
• Explicitly anti-racist. 
• Learner-centered. 
• Community-specific. 

Sex ed that is for everyone includes (but isn't limited to) information about:

• Healthy relationships.
• Anatomy and physiology. 
• Adolescent sexual development. 
• Gender identity and expression. 
• Sexual orientation and identity. 
• The full range of birth control methods and pregnancy options. 

All young people have a right to this kind of high-quality, evidence-based information and care to ensure their lifelong sexual and reproductive health. Again , and again , and again both national and international research has found that young people who have experienced comprehensive sexuality education delay having sex for the first time, are less likely to engage in risky behavior, and are more likely to use birth control. 

Plus, beyond giving young people facts, inclusive sex ed provides skills such as effective communication, active listening, and the ability to make informed decisions that will help them to grow and live safe, healthy, and fulfilling lives.   

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What Works In Schools : Sexual Health Education

CDC’s  What Works In Schools  Program improves the health and well-being of middle and high school students by:

• Improving health education,
• Connecting young people to the health services they need, and
• Making school environments safer and more supportive.

What is sexual health education?

Quality provides students with the knowledge and skills to help them be healthy and avoid human immunodeficiency virus (HIV), sexually transmitted infections (STI) and unintended pregnancy.

A quality sexual health education curriculum includes medically accurate, developmentally appropriate, and culturally relevant content and skills that target key behavioral outcomes and promote healthy sexual development. 1

The curriculum is age-appropriate and planned across grade levels to provide information about health risk behaviors and experiences.

Sexual health education should be consistent with scientific research and best practices; reflect the diversity of student experiences and identities; and align with school, family, and community priorities.

Quality sexual health education programs share many characteristics. 2-4 These programs:

• Are taught by well-qualified and highly-trained teachers and school staff
• Use strategies that are relevant and engaging for all students
• Address the health needs of all students, including the students identifying as lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ)
• Connect students to sexual health and other health services at school or in the community
• Engage parents, families, and community partners in school programs
• Foster positive relationships between adolescents and important adults.

How can schools deliver sexual health education?

A school health education program that includes a quality sexual health education curriculum targets the development of functional knowledge and skills needed to promote healthy behaviors and avoid risks. It is important that sexual health education explicitly incorporate and reinforce skill development.

Giving students time to practice, assess, and reflect on skills taught in the curriculum helps move them toward independence, critical thinking, and problem solving to avoid STIs, HIV, and unintended pregnancy. 5

Quality sexual health education programs teach students how to: 1

• Analyze family, peer, and media influences that impact health
• Access valid and reliable health information, products, and services (e.g., STI/HIV testing)
• Communicate with family, peers, and teachers about issues that affect health
• Make informed and thoughtful decisions about their health
• Take responsibility for themselves and others to improve their health.

What are the benefits of delivering sexual health education to students?

Promoting and implementing well-designed sexual health education positively impacts student health in a variety of ways. Students who participate in these programs are more likely to: 6-11

• Delay initiation of sexual intercourse
• Have fewer sex partners
• Have fewer experiences of unprotected sex
• Increase their use of protection, specifically condoms
• Improve their academic performance.

In addition to providing knowledge and skills to address sexual behavior , quality sexual health education can be tailored to include information on high-risk substance use * , suicide prevention, and how to keep students from committing or being victims of violence—behaviors and experiences that place youth at risk for poor physical and mental health and poor academic outcomes.

*High-risk substance use is any use by adolescents of substances with a high risk of adverse outcomes (i.e., injury, criminal justice involvement, school dropout, loss of life). This includes misuse of prescription drugs, use of illicit drugs (i.e., cocaine, heroin, methamphetamines, inhalants, hallucinogens, or ecstasy), and use of injection drugs (i.e., drugs that have a high risk of infection of blood-borne diseases such as HIV and hepatitis).

What does delivering sexual health education look like in action?

To successfully put quality sexual health education into practice, schools need supportive policies, appropriate content, trained staff, and engaged parents and communities.

Schools can put these four elements in place to support sex ed.

• Implement policies that foster supportive environments for sexual health education.
• Use health content that is medically accurate, developmentally appropriate, culturally inclusive, and grounded in science.
• Equip staff with the knowledge and skills needed to deliver sexual health education.
• Engage parents and community partners.

Include enough time during professional development and training for teachers to practice and reflect on what they learned (essential knowledge and skills) to support their sexual health education instruction.

By law, if your school district or school is receiving federal HIV prevention funding, you will need an HIV Materials Review Panel (HIV MRP) to review all HIV-related educational and informational materials.

This review panel can include members from your School Health Advisory Councils, as shared expertise can strengthen material review and decision making.

For More Information

Learn more about delivering quality sexual health education in the Program Guidance .

Check out CDC’s tools and resources below to develop, select, or revise SHE curricula.

• Health Education Curriculum Analysis Tool (HECAT), Module 6: Sexual Health [PDF – 70 pages] . This module within CDC’s HECAT includes the knowledge, skills, and health behavior outcomes specifically aligned to sexual health education. School and community leaders can use this module to develop, select, or revise SHE curricula and instruction.
• Developing a Scope and Sequence for Sexual Health Education [PDF – 17 pages] .This resource provides an 11-step process to help schools outline the key sexual health topics and concepts (scope), and the logical progression of essential health knowledge, skills, and behaviors to be addressed at each grade level (sequence) from pre-kindergarten through the 12th grade. A developmental scope and sequence is essential to developing, selecting, or revising SHE curricula.
• Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2021 , Atlanta: CDC; 2021.
• Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68(1), 13-27.
• Centers for Disease Control and Prevention (2016). Characteristics of an Effective Health Education Curriculum .
• Pampati, S., Johns, M. M., Szucs, L. E., Bishop, M. D., Mallory, A. B., Barrios, L. C., & Russell, S. T. (2021). Sexual and gender minority youth and sexual health education: A systematic mapping review of the literature.  Journal of Adolescent Health ,  68 (6), 1040-1052.
• Szucs, L. E., Demissie, Z., Steiner, R. J., Brener, N. D., Lindberg, L., Young, E., & Rasberry, C. N. (2023). Trends in the teaching of sexual and reproductive health topics and skills in required courses in secondary schools, in 38 US states between 2008 and 2018.  Health Education Research ,  38 (1), 84-94.
• Coyle, K., Anderson, P., Laris, B. A., Barrett, M., Unti, T., & Baumler, E. (2021). A group randomized trial evaluating high school FLASH, a comprehensive sexual health curriculum.  Journal of Adolescent Health ,  68 (4), 686-695.
• Marseille, E., Mirzazadeh, A., Biggs, M. A., Miller, A. P., Horvath, H., Lightfoot, M.,& Kahn, J. G. (2018). Effectiveness of school-based teen pregnancy prevention programs in the USA: A systematic review and meta-analysis. Prevention Science, 19(4), 468-489.
• Denford, S., Abraham, C., Campbell, R., & Busse, H. (2017). A comprehensive review of reviews of school-based interventions to improve sexual-health. Health psychology review, 11(1), 33-52.
• Chin HB, Sipe TA, Elder R. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med 2012;42(3):272–94.
• Mavedzenge SN, Luecke E, Ross DA. Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014;66:S154–69.

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Why education about gender and sexuality does belong in the classroom

Senior Lecturer, School of Education, Edith Cowan University

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There is currently no consistent standard of sex, sexuality, gender and respectful relationships education across Australian schools. Each state and territory makes decisions about what they teach in schools. Additionally, religious schools have exemptions under anti-discrimination laws to decide how they approach these issues, and whether they include them at all.

Despite the gains made in the marriage equality debate, Australia has been unable to translate this into inclusive sex and sexuality education for young people. While countries such as England and Canada are adopting progressive, consistent sex education programs at a national level, Australia has not.

Read more: Australian sex education isn't diverse enough. Here's why we should follow England's lead

The federal Department of Education is spending A$5 million to develop resources to teach respectful relationships in Australian schools. According to one news report , these resources will not include topics on toxic masculinity, gender theory or case studies about young people’s sexual activity. This project is a part of the women’s safety package announced in 2015 by the Turnbull government, which seeks to educate young people about violence against women.

The federal government is quietly trying to distance these resources from Victoria’s Respectful Relationships program, which has been criticised by some conservative commentators. Politics aside, there is an urgent need for these resources. Gendered violence against women and LGBTIQ people is too common in Australia.

No more federal funding for Safe Schools

Only a few years ago, Australia was very close to having a standard national resource for sex, sexuality and relationships education – the Safe Schools program. Its creators aspired to consistency across all state and territory educational jurisdictions in Australia, in line with the nationally consistent Australian Curriculum .

Safe Schools was designed as an evidence-based , educational anti-bullying program. The program had LGBTIQ inclusion at its core, and sought to create safe and inclusive environments for LGBTIQ students. Resources used to help deliver the program were developed by experts and carefully selected to ensure they were age-appropriate for the students using them.

The federal government stopped funding the program in mid-2017, following an extended public pillorying by conservative politicians and media commentators . This ranged from concern students were encouraged to cross-dress and role-play as gay teenages to false claims the program showed children how to masturbate and strap on dildos.

Read more: FactCheck: does the Safe Schools program contain 'highly explicit material'?

An inconsistent approach

Safe Schools has been replaced by an eclectic mix of programs, which vary from state to state. As a result, Australia has an inconsistent approach across state education systems.

In Victoria, the Building Respectful Relationships program was trialled in 2015 in response to recommendations Royal Commission into Family Violence and rolled out more broadly since 2016.

The program contains strong messages of healthy relationships, violence prevention and control, which young people can relate to, regardless of their situation. The program has received criticism claiming it’s simply a repackaged version of the Safe Schools program. It runs concurrently with Safe Schools, which is now implemented in nearly all government secondary schools in Victoria.

Safe Schools programs are also run in one government school in the NT, 21 government schools in Tasmania and 24 government schools, 3 independent schools and 3 other educational settings in WA.

At the federal level, funding has been confirmed to make the John Howard-inspired school chaplain program permanent. The School Chaplaincy program is intended to support the social, emotional and spiritual well-being of school communities across Australia. This may include support and guidance about ethics, values, relationships and spiritual issues.

Federal discomfort with sex, sexuality and gender discussions

Scott Morrison has made a number of comments about LGBTIQ issues in his short time as Prime Minister. Morrison said schools don’t need “gender whisperers”, referring to an article which stated teachers were being taught how to spot potentially transgender students.

It has since been clarified teachers were being trained on how to support students if they identify as transgender, not to identify potentially transgender students.

Morrison has also brushed aside concerns about gay conversion therapy , and publicly stated he sends his children to a religious schools to avoid “ skin curling ” discussions about gender diversity and sexuality.

Other members of the Coalition have publicly echoed similar beliefs, including Tony Abbott and Tasmanian Liberal senator Eric Abetz who actively spoke out against voting “yes” in the same-sex marriage plebiscite for fear it would lead to a “ radical sex education program for schools ”.

A strong case for sexuality, gender and sex education

Gender and sexual diversity are part of the rich multicultural landscape of contemporary Australian society. But research indicates there’s significant cause for concern about gender-based violence and family violence. Education about respectful relationships was identified as a key way to combat this in the Royal Commission into Family Violence .

Likewise, current research about young people and sex, sexuality and gender diversity is alarming. There are still high levels of mental health issues (such as depression, anxiety, self-harm, and suicide) among LGBTIQ young people as a result of bullying, discrimination, and harassment at school and in the wider community.

The data indicate increasingly high rates of sexually transmitted infections (STIs) among young people are also a significant concern. Rates of chlamydia and gonorrhoea diagnoses in Australia are highest amongst people aged 15-24 years .

Regardless of sexual orientation or gender identity, research indicates young people need to be reliably informed about safe sex. The ramifications of not doing so are far too significant. Research shows school-based sexuality education improves sexual health outcomes for young people.

Likewise, Australia has unacceptably high rates of family, domestic and sexual violence, while gender inequality permeates most aspects of society. This can be mitigated through reliable education about healthy relationships. Family, domestic and sexual violence is not a sign of a healthy society .

Read more: Young people want sex education and religion shouldn't get in the way

Sex, sexuality, respectful relationships, and gender all need to be discussed in schools as a component of a whole-school approach. This should not only include in-class education, but it should also be addressed in school cultures, policies and procedures, and in gender equity among the staff.

This is important because we need safe, inclusive schools that celebrate diversity. It’s also important to raise awareness among young people to mitigate family, domestic and sexual violence.

This article has been updated since publication to clarify that there are government schools in Victoria which run Safe Schools programs, and that the Building Respectful Relationships program is run concurrently, not as a replacement.

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Let's talk about (queer) sex: The importance of LGBTQ-inclusive sex education in schools

Editor's note: This story originally published in August 2021.

What's a three-letter word that prompts parents to pontificate and teens to plug their ears when their parents bring it up? 

You guessed it: S-e-x.

Just because teens can be hesitant to talk with their parents about sex  isn't a reason to give up on the conversation. Not talking about it could be dangerous or even deadly, and markedly so for  LGBTQ youth .

Just 8.2% of students said they received LGBTQ-inclusive sex education, according to LGBTQ education nonprofit GLSEN's National School Climate Survey in 2019 . It's not shocking when you uncover that it's only mandated in a minority of U.S. states.

Melanie Willingham-Jaggers, director of GLSEN, compares the fight for inclusive sexual education to that of critical race theory, noting   people can favor long-held narratives over the truth.

"What we're having right now in our country is a debate around what responsibility we have to our children when it comes to educating them," Willingham-Jaggers says. "Queer, inclusive sex ed is not critical race theory. But what you see in both of these arguments is do we teach our children what is true in reality and history and nature? Or do we teach them what we want them to know?"

Sex education looks drastically different depending on where you live (though  legislation  is ongoing ).

• Thirty-nine states, plus Washington, D.C., require sex education and/or HIV education in schools, according to the Guttmacher Institute . But only 18 states mandate that sex and HIV education  be medically accurate.
• As for LGBTQ inclusivity: 11 states (and D.C.) call for "inclusive content with regard to sexual orientation."
• But on the other side of the coin, five states allow negative  information on homosexuality and/or a  positive push for heterosexuality. If you live in a state like Florida or South Carolina, for example, your children may be taught sexual education that discourages queer sex. 

Heads up: 'Pray Away' details trauma of LGBTQ conversion therapy – and new leaders are still emerging

What a lack of sex education means for LGBTQ youth

Dio Anthony , a 31-year-old writer in New York, remembers little about his high school sex education experience beyond   a weeklong course on sex.

"They weren't teaching you how to apply a condom like they show you in the movies," he says.

When he first slept with a man at 16, he had no idea what was going on. Future sexual encounters were not fun. He grew uncomfortable sharing details of his sexual escapades in his 20s even though his friends hooted and hollered about theirs.

"When we exclude LGBTQ+ young people from comprehensive education, we make them more isolated, behave in more risky ways and they are further pushed out and pushed into dangerous situations where negative outcomes are more likely," Willingham-Jaggers says.

The Human Rights Campaign Foundation found that LGBTQ youth, particularly Black and Latino LGBTQ youth, rarely receive sex education at school that is relevant to them.

This pattern reveals itself through statistics: Of the 36,801 people diagnosed with HIV in 2019 in the U.S., 25,842 were Black or Latino, according to the Centers for Disease Control and Prevention . That's over 70%. 

"It isn't an accident that HIV is still so prevalent where it's prevalent," says   Justin A. Sitron , associate dean of the College of Health and Human Services at Widener University. "It's because the public health system has not responded to both the access needs, and the cultural realities that men of color especially face." Widener University's Interdisciplinary Sexuality Research Collaborative is behind the website swagtoolkit.com , aimed at providing sex education to Black gay and bisexual men.

Such websites prove crucial, considering how often people pepper their search engines with questions – particularly about taboo topics, Sitron says. 

"Without LGBTQ+ inclusive sex education, queer and trans youth are left in the dark when it comes to making informed decisions about their health, understanding their body, understanding how their body relates to other bodies out in the world," Willingham-Jaggers says. "When sex education labels some topics as controversial, it hurts all students by failing to provide a full and medically accurate understanding of sexual health."

LGBTQ young people get stuck at questions like, "'So I know I'm supposed to wear a condom when I have anal sex. But, like, what is anal sex?' " Sitron says. 

In case you missed: LGBTQ students need inclusive sex ed – but less than 10% in US are receiving it, report says

LGBTQ advocates change landscape of sex education

LGBTQ advocates are battling preconceived notions of sex education.

Scout Bratt, outreach and education director at Chicago Women's Health Center, directs a program of sexual health education for Chicago public schools and area universities; they work with fourth through 12th graders as well as college students. Yes, inclusivity begins as young as fourth grade: Instead of saying girls menstruate or boys produce sperm, for example, you can say people who menstruate and people who produce sperm to incorporate trans and nonbinary people.

"We are trying to infuse queer inclusivity and gender expansiveness in the curriculum across all grade levels across all subjects," Bratt says.

Sexual health educator  Shafia Zaloom  consults around the country with schools about sexuality, and notes that curriculums vary among different types of schools – i.e., public schools don't have the same standards as independent schools.

After receiving feedback from LGBTQ youth, Zaloom worked to create a program that went in-depth on LGBTQ issues led by queer staff.

"When we provide kids with really inclusive, comprehensive sex education, they grow up to have more bodily autonomy, more healthy perspectives on their sexuality, they tend to delay and make more responsible decisions and be far more relational and communicative in their relationships," Zaloom says.

Aww: ‘Sesame Street’ to ‘Ridley Jones’: TV shows are teaching kids about LGBTQ issues, diversity

Where to turn if your school isn't teaching LGBTQ-inclusive sex education

• Get involved in advocacy work . "The states that have passed comprehensive LGBTQ inclusive sexual health education laws did not happen because one person raised their hand and said, 'We should have that.' It took time, it took advocacy, it took education," Vincent Pompei, director of the Human Rights Campaign's Youth Well-Being Program. says. "What we need to do is provide opportunities for communities and parents and educators to understand why it's essential."
• Turn to your local community.  Health educators, doctors and other sexual education resources and community centers abound. Talk to them, Sitron advises.
• Look online for resources – but verify them. Planned Parenthood, Advocates for Youth and SIECUS are all solid resources, according to Sitron. Don't underestimate YouTube channels either. "When you live in a highly stigmatized area and you have no support, online might be the only community that you might be able to find," says Carmen Mojica, a reproductive justice movement leader. "And I don't think that there should be any shame in that." See also GLSEN and HRC .
• Adults, affirm your children.  Sitron recommends doing away with your helicopter parent mindset and becoming more of a partner to your child as they navigate their concerns.
• Children, talk to adults. Spend some alone time with your doctor without your parents if you have any specific questions, Sitron says. Bratt adds that young people are leading this movement – so adults, make time to listen. 

Above all, remember this: Sex should make you feel good – and feel good to talk about.

"It should be one of the things in our lives that makes us the most joyful," Sitron says. "And when queer people don't get to have that because their sex is problematized, we miss out on such an opportunity to be joyful and happy."

Hear, hear: We need to celebrate LGBTQ joy. Lives depend on it.

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Feature Story

Feature story

The importance of comprehensive sexuality education for africa’s young people.

07 December 2021

A message of support for the ESA Commitment from Professor Mbulelo Dyasi, Vice Chair, Board o

A message of support for the ESA Commitment from Professor Mbulelo Dyasi, Vice Chair, Board of Directors, INERELA+, delivered at ICASA 2021

As religious leaders, we have a trusting relationship between us and our congregations. As beholders of God’s truth and a belief system based on faith, our relationships with our congregants and communities are based on a strong basis of belief and as custodians of good values. This provides us with a platform to advocate and motivate for the betterment of our people from a faith perspective while we can also work together with our congregations in finding solutions to the challenges they face in their environments.

Today, we are in a situation where our nation and our continent are at the right place to advance in areas of economics, infrastructure and human resources. This is because we have young populations who are fast growing up to be productive citizens. These young people need direction and guidance to be able to make good decision, have positive family lives and be good citizens. And as religious leaders we play an important role in providing this guidance. Parents in our congregations know their role in providing this guidance. And we live in a modern society with modern education and health systems, so we need teachers, social workers and health workers to also provide this guidance. Each has a role to play in improving society.

We trust a government that acts in our best interests. Since 2000, the South African Government has been providing our children with the education and guidance they need. This education, called Life Orientation/Life Skills, where sexuality education is embedded, complements the values and direction that we provide as religious leaders through our sermons and that parents provide at home. We have to make sure that our children can negotiate issues of sexuality and relationships from a position of knowledge and power, rather than a position of ignorance and fear. From a position of truth and science, rather than a position of misinformation and helplessness.

There are those who try to spread fear and disinformation, creating panic and claiming to be the guardians of family values. The truth is that many of us who are believers, who are parents, who are teachers, are united on human dignity. And sexuality education promotes human dignity. Because sexuality education ensures that our children learn to treat each other with respect and dignity from an early age. It ensures that our children learn to think about what is right and safe for them, and how to avoid coercion, sexually transmitted infections, including HIV, and early and unintended pregnancies. It helps to keep our children safe from abuse by teaching them about their bodies.

Young Africans must have the facts and confidence to stay safe and healthy, live a dignified life and contribute positively to their community and countries. They must trust us, their elders, to tell them the truth. Therefore, as religious leaders we pledge our support today to the ESA Commitment, which seeks to enhance efforts in ensuring the health and well-being of our children and young people. We commit to work with our governments to accelerate action towards realizing the agreed upon targets so that in 2030 we can all see the vision of an AIDS-free generation.

As religious leaders we hereby endorse the ESA Commitment towards 2030 aiming to ensure that we close the gap of comprehensive knowledge of our young people to protect themselves from new HIV infections, early and unintended pregnancies and gender-based violence and early child marriages. We promise to engage with our constituencies to create an enabling environment for adolescents and young people to access sexual and reproductive health services and use our platforms to empower parents to be able to talk with their children on issues affecting their health and well-being. With the challenge of COVID-19, we also commit ourselves to work together with our communities in finding innovative ways to ensure access to information and essential services during times of crisis. Working together we will surely win the fight against HIV and other pandemics.

Professor Mbulelo Dyasi, Vice Chair, Board of Directors, INERELA+

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