sex education in schools curriculum

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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The Importance of Comprehensive K-12 Sexual Education Programs

Tatiana M. Smith, University of New Haven

The purpose of this paper is to discuss the current status of existing evidence-based health education programs designed for K-12 students. The content of well-informed K-12 health education programs is intended to clarify definitions and reduce future at-risk and criminal behaviors. This may include evidence-based curriculums encompassing such topics as mental health, sexual education, learning difficulties, sexuality, bullying, suicide, substance abuse, biological puberty, and more. However, the focus here will be on sexual education curriculums for K-12 health education programs. The goal is to evaluate whether existing health programs properly educate K-12 students about recognizing and practicing positive interactions within sexual situations. The intended audience includes legislators and school administrators who effect policy changes in K-12 academic public-school curricula (specifically sex education), with the expectation of enhancing course content to be more comprehensive and to decrease the likelihood of at-risk and criminal behavior in the future, both in the U.S. and perhaps globally (Leung, Shek, Leung, & Shek, 2019).

K-12 Sexual Health Education Programs

According to the Bureau of Justice Statistics (Morgan & Oudekerk, 2018), from 2017 to 2018, the rate of sexual assault among victims 12-years old or older increased from 1.4 to 2.7 per 1,000 persons. This increasing rate of victimization is in line with recent research from the Centers for Disease Control and Prevention (CDC, 2019). An updated release of the National Intimate Partner and Sexual Violence Survey (NISVS) data illustrates the risk to male and female victims, between ages 10-17, to be approximately 1 in 4 and 1 in 3 individuals, respectively (Smith, Zhang, Basile, Merrick, Wang, Kresnow, & Chen, 2018).

These data reveal the ongoing threat of sexual offending and violence among youth. The importance of this information is linked to sexual education programs for K-12 students, which is present in less than 30 states (Fay, 2019). Based upon state laws and corresponding education standards, existing sexual education programs discuss healthy relationships, sexual assault, and/or consent in only 11 states and the District of Columbia (Shapiro & Brown, 2018). In sum, the availability and standards of sex education programs in public schools are widely diverse.

The National Institute of Health reports that between 20 and 27 states only require sexual education on topics that include contraception, sex and/or HIV education, abstinence-only, and sexual activity only being acceptable within marriage (Shapiro & Brown, 2018; National Conference of State Legislatures (NCSL), 2020). Furthermore, states provide parental rights concerning the curriculum that public schools enact, including notification of parents, requiring parental consent, and/or allowing parents to opt-out of sexual education on behalf of their children (NCSL, 2020).

  Background

The history of sex education in the United States has been widely debated for decades, dating to the 1960s, on whether to become more restrictive or more comprehensive (NCSL, 2020; Planned Parenthood, 2016; Schmidt et al., 2015). Sex education has diverged into separate directions across U.S. schools, when it is present. Research has found that previous approaches intending to provide medically comprehensive information about sexual health are not the most successful at reducing risk-taking behaviors among youth (Planned Parenthood. 2016). Rather, studies have uncovered evidence indicating comprehensive programs are successful when they include health goals, preventive methods, physical/psychosocial risk and protective factors, fostering of safe environments, and the incorporation of active participation and multiple activities throughout the course (Planned Parenthood, 2016; Leung et al., 2019).

Sexual Health Education Curricula

The issue of a widely inconsistent and generally lacking sexual education curriculum, both nationally and internationally, is becoming more and more relevant. Rates of sexual violence victimization are not decreasing, but instead have been increasing, even in the context of substantial non-reporting (Smith et al., 2018; Morgan & Oudekerk, 2018; CDC, 2019). The purpose of drawing attention to the improvement of existing sexual education curricula is to decrease rates of sexual violence victimization in the future. The implementation of evidence-based comprehensive programs has shown positive results in prior studies, in that the risk-taking behaviors of youth decreased (Planned Parenthood, 2016). A review of current state legislation indicates, however, at least half of the nation receives limited to no sexual education in K-12 public schools (Planned Parenthood, 2016; Leung et al., 2019; NCSL, 2020).

This educational gap deprives K-12 students from learning about proper sexual health, healthy sexual interactions, the meaning and importance of consent, healthy relationships, sexuality, gender discussions, the significance of behavior, and more (Shegog, Baulmer, Addy, Peskin, & Thiel, 2017; Schmidt, Wandersman, & Hills, 2015; Shapiro & Brown, 2018; Leung et al., 2019; NCSL, 2020). The lack of action to enact new legislation, which could enhance sex education curricula, reduces the likelihood of declines in sexual victimization, including at the developmental stages for K-12 students (Mallet, 2017; CDC, 2019; Leung et al., 2019; NCSL, 2020; Shapiro & Brown, 2018; Smith, Park, Ireland, Elwyn, & Thornberry, 2013).

Pre-Existing K-12 Sexual Health Education Policies

The American public has been demanding an increased focus in schools on teen pregnancy and unhealthy relationships, but sex education standards vary significantly across states, preventing access to critical intervention tools that would provide more comprehensive sex education for students (Shapiro & Brown, 2018). This unbalanced focus creates vulnerability amongst K-12 students for increased risk of victimization and perpetration.

As previously discussed, sex education is not mandated nationwide, nor is the curriculum consistent across states that have implemented legislation. This disparity continues to impact young adults after graduation, placing them at a higher risk for a variety of social and health problems unknown to them (Fay, 2019). The benefit of updated legislation nationwide, in a comprehensive and uniform manner, would be in producing more informed students who will have the ability to make better decisions (Fay, 2019). Knowledge is power, and nearly half the nation does not have any form of sex education in their K-12 public schools, while the majority of those that have programs focus solely on abstinence, sex within marriage, contraception, and/or medically accurate information (Fay, 2019; Leung et al., 2019; NCSL, 2020).

Despite research showing these restrictive educational curricula to be ineffective, the movement to strengthen legislation on sex education requirements and make programs more comprehensive does not have strong traction nationwide (Fay, 2019; NCSL, 2020; Leung et al., 2019; Smith et al., 2013; Planned Parenthood, 2016). Lack of action by legislators in states with restrictive or non-existent programs suggests there is little desire to change or create policies, despite public health risks (CDC, 2019; Planned Parenthood, 2016; Shapiro & Brown, 2018).

Presently, there are no known specific programs that focus on non-heterosexual orientations, nor do existing sexual education courses give much attention to this topic (Schmidt et al., 2015). Although the majority of sexuality education programs in U.S. schools discuss sexually transmitted diseases, pregnancies, abstinence, and the use of contraception, there is a significant amount of content missing (Schmidt et al., 2015). For instance, such topics as what constitutes a healthy dating relationship, interpersonal violence, consent, and discussion of gender roles often are not included (Children & Families Directorate, 2019; Planned Parenthood, 2016; Schmidt et al., 2015; Shegog et al., 2017).

K-12 Sexual Health Education Policy Options

An initial policy proposal can be modeled after a study that associated professional development of teachers with increases in sexual education content coverage (Clayton, Brener, Barrios, Jayne, & Jones, 2018). This model acknowledges the efficacy of sexual health education for middle and high school students, which could be utilized for policies that provide guidance for K-12 sexual health education (Clayton et al., 2018). The positive impact uncovered in the study suggests that professional development of teachers is essential, as they are more likely to teach an expansive content of sexual health than are teachers without similar experience.

A second policy proposal may be constructed using the Reproductive Health Education (RHE) programs implemented and analyzed through a study focused on middle school students from Lebanon (Mouhanna, DeJon, Afifi, Asmar, Nazha, & Zurayk, 2017). These programs also found positive associations between expanded program content and student outcomes. Furthermore, this study developed a baseline for future research on this issue, to be used in informing future stakeholders and assessing the necessity and implementation of RHE programs in developing countries (Mouhanna et al., 2017).

A third and final policy proposal follows the structure of a peer education program known as Students with a Realistic Mission (SWARM; Butler, Jeter, & Andrades, 2002). This program model was found to be successful in integrating service learning and peer education within the health education curriculum (Butler et al., 2002). The original SWARM program included a focus on drugs, service learning, and healthy living-learning competencies. Additionally, it incorporated student feedback, which had been largely positive but included constructive criticism (Butler et al., 2002). Due to its earlier success and integration into an academic institution, a collaborative approach with education and community aspects likely would be an adaptable policy option for K-12 sexual health education.

Advantages of Each K-12 Sexual Health Education Policy Option

The advantages of the first policy proposal modeled after the combination of professional development of teachers and expanded content coverage in K-12 sexual health education (Clayton et al., 2018) may include:

 Focus on preventing adverse sexual behavior and subsequent consequences.  Professional development specifically targeted to teaching sexual health content.  Focus on teaching four domains (including several specific topics under each domain):

o Human sexuality o Pregnancy prevention o HIV prevention o Sexually transmitted diseases prevention.

 Middle and high school sexual education courses.  Reducing sexual risk behaviors and increasing adult/parental support for school-based sexual health education.  Teachers achieving expertise through preservice training.

The advantages of the second policy proposal, constructed using RHE programs with a focus on middle school students from Lebanon (Mouhanna et al., 2017), may include:

 Advocacy and effective implementations of RHE programs for greater numbers and types of youth.  Tailored interventions for the needs, concerns, and expectations of students.  Young people being educated to make informed decisions for their sexual health.  Expanded health education topics reviewed in school.

Finally, the advantages of the third policy proposal follow the structure of the SWARM program, which provides integrated service learning and peer education in the health education curriculum (Butler et al., 2002), and may include:

 Aspects of the community, peers, youth, and academic collaboration in the health education curriculum.  Primary focus on HIV/AIDS, STD prevention, alcohol, and drug education, with possible incorporation of sexual health education  Student feedback, including thoughtful and constructive criticism.

Disadvantages of Each K-12 Sexual Health Education Policy Option

The disadvantages of the first policy proposal (Clayton et al., 2018) may include:

 The preservice and ongoing educational training required may be a challenge due to issues with training, funding, and administrational support.  This could result in time management issues (i.e., overburdening teachers with requirements and little or no support).  Subjects such as mandating the use of condom instruction and discussing sexual orientation might be challenging.

The disadvantages of the second policy proposal (Mouhanna et al., 2017) may include:

 Lack of generalizability and replication of research on this program.  Variation in culture, attitudes, religion, and political orientation might impact implementation and effectiveness.

The disadvantages of the third policy proposal (Butler et al., 2002) may include:

 Limited research on the continued success of SWARM.  Little research on whether significant challenges have been identified since the initial analysis.

Recommendations for a K-12 Sexual Health Education Policy

An overall general recommendation would be to utilize an evidence-based program to restructure sexual health education in K-12 schools in the United States, with an emphasis on a collaborative approach at the micro and macro levels (Schmidt et al., 2015; Whillier, Spence, Giuriato, & Chiro, 2019). This could include, for instance, collaboration between academics, researchers, legislators, community leaders, and school personnel. Evidence-based curricula have been shown to be successful in U.S. school settings. However, for successful implementation, the curricula cannot be compromised by content and competing academic priorities (Shegog et al., 2017).

Based upon the three proposed policy options, the most effective and realistic option would likely be based on the first policy model. Research successfully associated ongoing professional development of teachers with a current, well developed curriculum in K-12 school-based sexual health education programs (Clayton et al., 2018). Ongoing professional development requirements for sexual health educators, combined with their educational pedigree upon entry into their position, could create a highly informed and comprehensive curricula in K-12 schools.

The addition of qualified sexual health educators and ongoing professional development requirements could aid in implementing K-12 school-based sexual health educational programs nationwide. This may be especially influential for policy legislators and in generating parental support, particularly in areas where sexual health education is presently limited or non-existent. The choice of this recommendation is intended to minimize at-risk behaviors, in addition to reducing both criminal victimization and perpetration.

Annotated Bibliography

Butler, K. L., Jeter, A., & Andrades, R. (2002). SWARMing for a solution: Integrating service learning and peer education into the health education curriculum. American Journal of Health Education, 33(4), 240-244. https://eric.ed.gov/?id=EJ854088 Butler, Jeter, & Andrades (2002) evaluated the program Students with a Realistic Mission (SWARM), which focused on health concerns such as drugs, alcohol, HIV/AIDS, and STD prevention. This article provides the framework for an integrated health education program that could be the basis for proposed legislation for comprehensive sexual education. This framework is especially resourceful as it has a successful history, and feedback had been both largely positive and constructive.

Centers for Disease Control and Prevention (CDC). (2019). CDC healthy school. National health education standards. https://www.cdc.gov/healthyschools/sher/standards/index.htm The Centers for Disease Control and Prevention provides an outline for National Health Education Standards (NHES) that pertain to education frameworks and curricula created for K-12 students. There are eight standards that discuss the required depth of ability students much reach at each stage. Furthermore, there is assistance provided to use characteristics associated with the creation of an effective health education curriculum.

Children and Families Directorate. (2019, May 17). Key messages for young people on healthy relationships and consent: A resource for professionals working with young people. Scottish Government. https://www.gov.scot/publications/key-messages-young-people-healthy-relationships-consent-resource-professionals-working-young-people/pages/3/ The Children and Families Directorate provides a resource for professionals to consult when creating well-informed curricula in sex education for young people. It provides a model created recently by the Scottish Government which is concise and informative, especially regarding legislation and/or curricula that may not have an existing framework to amend or build upon.

Clayton, H. B., Brener, N. D., Barrios, L. C., Jayne, P. E., & Jones, S. E. (2018). Professional development on sexual health education is associated with coverage of sexual health topics. Pedagogy in Health Promotion: The Scholarship of Teaching and Learning, 4(2), 115-124. doi: 10.1177/2373379917718562 This article examined sexual health education programs emphasizing the professional development of teachers with a focus on middle and high school health education courses. This study illustrates the importance of comprehensive sexual health education, as it is essential in the prevention of sexual behavior consequences. This structure for professional development associated with school-based sexual health education has proven to be effective, with a positive impact on both the health content covered and the students.

Fay, L. (2019, April 1). Just 24 states mandate sex education for K-12 students, and only 9 require any discussion of consent. See how your state stacks up. The 74 Media: The Big Picture. https://www.the74million.org/article/just-24-states-mandate-sex-education-for-k-12-students-and-only-9-require-any-discussion-of-consent-see-how-your-state-stacks-up/ Fay discusses the attention that sexual education programs in the United States are receiving, both in content and state education requirements. This article further states that during Sexual Assault Awareness Month, lawmakers have been considering legislation related to sex education for K-12 students. It is important to stress that the bills vary in whether the comprehensive nature of the sex education course requirements will be strengthened or restricted.

Leung, H., Shek, D. T. L., Leung, E., & Shek, E. Y. W. (2019). Development of contextually- relevant sexuality education: Lessons from a comprehensive review of adolescent sexuality education across cultures. International Journal of Environmental Research and Public Health, 16(4), 1-24. doi: 10.3390/ijerph16040621 The authors provide a comprehensive review of literature of sexuality education in the United States as well as abroad. This article reviews the policy, practice, training, evaluation, and research associated with the sex education programs in each of the evaluated countries. This highly comprehensive approach illustrates concern over the effectiveness of sexuality programs has been increasing globally, with youth specified as the target population. Furthermore, this review also supports the need for a more informed perspective and curricula that will enhance the effectiveness of these programs.

Mallett, C. A. (2017). The school-to-prison pipeline: Disproportionate impact on vulnerable children and adolescents. Education and Urban Society, 49(6), 563-592. doi: 10.1177/0013124516644053 Mallet presents the significant effect that a punitive school environment can have upon child and adolescent groups, specifically in urban schools. This study examines how certain traits may act as vulnerabilities such as their sexual orientation, socioeconomic class, race, disabilities, and more place these individuals at risk for what has become known as the school-to-prison pipeline. It is important to consider not only academics, but also the environmental factors that may increase an individual’s vulnerability to future criminal victimization or perpetration.

Morgan, R. E., & Oudekerk, B. A. (2019). Criminal victimization, 2018. The Bureau of Justice Statistics. U.S. Department of Justice: Office of Justice Programs. https://www.bjs.gov/content/pub/pdf/cv18.pdf This brief provides the most recently collected data from the Bureau of Justice Statistics regarding a range of criminal victimization, such as aggravated assault, sexual assault, robbery, and stranger violence. The authors provide data on the current rate of victimization regarding sexual assault victims from 2017 to 2018, which subsequently suggests a rise in victimization.

Mouhanna, F., DeJong, J., Afifi, R., Asmar, K., Nazha, B., & Zurayk, H. (2017). Student support for reproductive health education in middle schools: Findings from Lebanon. Sex Education, 17(2), 195-208. doi: 10.1080/14681811.2017.1280011 The authors present a study that acknowledges the critical developmental phase of youth can be more vulnerable to risky sexual behaviors and the associated negative health outcomes. This study is significant as it recognizes the importance of school-based health programs that are well-informed, as well as the significance of grade level and exposure to additional health education topics. This design would be a valuable model to replicate, as effective programs enhance positive attitudes and their implementation could be tailored to key interventions with specific individuals.

National Conference of State Legislatures (NCLS). (2020, April 1). State policies on sex education in schools. Why is sexual education taught in schools? https://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx The National Conference of State Legislators provides updated information as of March 1, 2020 regarding the sex education for public schools in all states. The brief includes summaries of state laws for the medical accuracy in sex or HIV education specifically. However, it does not include the same comprehensive summaries about other sex education programs and their content.

Planned Parenthood. (2016). History of sex education in the U.S. https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-a446d90fd1e3/20170209_sexed_d04_1.pdf This Planned Parenthood brief reviews the history of sex education in the United States. This is significant brief, as it includes the World Health Organization’s (WHO) definition of sexual health, in addition to the curriculums and programs offered nationally and worldwide, including content evaluations, roles of the educators, agency roles, and parental roles. Furthermore, this brief acknowledges the concerns of this education curricula, the evolving differences in understanding sex education, as well as associated goals.

Schmidt, S. C., Wandersman, A., & Hills, K. J. (2015). Evidence-based sexuality education programs in schools: Do the align with the national sexuality education standards? American Journal of Sexuality, 10(2), 177-195. doi: 10.1080/15546128.2015.1025937 This article presents an evidence-based review of sexuality education programs in a sample of 10 schools from the Office of Adolescent Health (OAH). This analysis assesses whether the programs are following a comprehensive education model endorsed by the National Sexuality Education Standards. This review is essential, as it highlights pros and cons of the sexuality education programs based upon the level of comprehensiveness regarding the content.

Shapiro, S., & Brown, C. (2018, May 9). Sex education standards across the states. Center for American Progress. https://www.americanprogress.org/issues/education-k-12/reports/2018/05/09/450158/sex-education-standards-across-states/ Shapiro and Brown present a brief that discusses the importance of states moving towards a comprehensive sex education curriculum and current state sex education standards. This brief also highlights the significant diversity in state sex education standards in public schools nationally, but also cautions against focusing on limited topics like teen pregnancy and abstinence. The authors further emphasize the importance of consistent messaging as opposed to the current structure, which may produce inconsistent, confusing, and/or misleading information about sex education.

Shegog, R., Baumler, E., Addy, R. C., Peskin, M., & Thiel, M. A. (2017). Sexual health education for behavior change: How much is enough? Journal of Applied Research on Children: Informing Policy for Children at Risk, 8(1), 1-13. This article highlights the importance of an evidence-based program on sexual health curricula at the K-12 education levels. The authors discuss the significant impact of competing academic priorities, such as standardized testing schedules, which do not always enable students to receive effective sexual health curricula through both the quantity and quality of a program’s exposure.

Smith, C. A., Park, A., Ireland, T. O., Elwyn, L., & Thornberry, T. P. (2013). Long-term outcomes of young adults exposed to maltreatment: The role of educational experiences in promoting resilience to crime and violence in early adulthood. Journal of Interpersonal Violence, 28(1), 121-156. doi: 10.1177/0886260512448845 This study examines whether educational experiences in adolescence may have any mitigating impact on exposure to maltreatment and/or violence in early adulthood. The authors found that while a high G.P.A. had the most positive association with resilience to crime and violence, that the study’s results were consistent with literature that associates promotion of school achievement to increase resilience in urban youth.

Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M., & Chen, J. (2018). The national intimate partner and sexual violence survey (NISVS): Data brief – Updated release. Atlanta: GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 1-25. The National Intimate Partner and Sexual Violence Survey (NISVS), originally collected in 2015 and recently updated in 2018, includes qualitative and quantitative data that relates to current victimization rates. These surveys provide rates that may not have been captured in other data sets to more accurately highlight the risk of sexual violence in the United States among different gender, age, and racial groups.

Whillier, S., Spence, N., Giuriato, R., & Chiro, G. D. (2019). A collaborative process for a program redesign for education in evidence-based health care. The Journal of Chiropractic Education, 33(1), 40-48. doi: 10.7899/JCE-17-31 The authors provide a perspective, not focused on sexual education curricula for K-12 students, which advocates for the importance of a restructured program created through a collaborative process. This supports the need for sexual education to be restructured nationally while acknowledging that this cannot be accomplished nor implemented successfully without collaboration. For instance, a program that is created with research experts, academics, professionals, community leaders, and state officials.

Photo by Aaron Burden on Unsplash

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Sexual Health Education

Laurie dils.

Senate Bill 5395 , passed by the Legislature and Washington voters in 2020, went into effect on December 3, 2020 (see Bulletin 092-20 ). It requires all public schools to provide comprehensive sexual health education (CSHE) to all students by the 2022–23 school year.

• School district materials and resources
• Parent/guardian materials

Requirements

By the 2022-23 school year, all schools must provide comprehensive sexual health education (CSHE) to all students. All students includes any student enrolled in a district or public charter school, such as those in special education programs, online learning or alternative learning experiences, etc.

Instruction must be consistent with Health Education K-12 Learning Standards , which provide a framework for comprehensive instruction and the provisions of the law. Grade-level outcomes are provided as examples only and do not represent a required course of instruction. Instruction must also be age-appropriate, medically and scientifically accurate, and inclusive of all students, using language and strategies that recognize all members of protected classes.

• Schools must provide social emotional learning (SEL) to students in grades K−3. There is no sexual health content required for students in grades K–3.
• Schools must provide CSHE at least once in grades 4−5. "Once" will generally be a unit of instruction in at least one grade, with enough instruction to address required content and skill development as reflected in the Health Education K-12 Learning Standards.
• Schools must provide CSHE at least twice in grades 6−8 and at least twice in grades 9−12. "Twice" will generally be two units of instruction in at least two grades per grade band, with enough instruction to address required content and skill development as reflected in the Health Education K-12 Learning Standards.
• Instruction must include language and strategies that recognize all members of protected classes.
• Schools must inform OSPI of any curricula used to provide comprehensive sexual health education and describe how their instruction aligns with the requirements of the bill (OSPI has provided a reporting tool).

The required content is:

• In grades K-3, instruction must be in Social Emotional Learning (SEL) - learning to do things like manage feelings, set goals, and get along with others. Instruction must be consistent with Social Emotional Learning Standards and Benchmarks . (Note: there is no sexuality content required for students in grades K-3.)
• The physiological, psychological, and sociological developmental processes experienced by an individual;
• Abstinence and other methods of preventing unintended pregnancy and sexually transmitted diseases;
• HIV/AIDS prevention starting no later than 5th grade (per RCW 28A.230.070);
• Health care and prevention resources;
• The development of intrapersonal and interpersonal skills to communicate, respectfully and effectively, to reduce health risks and choose healthy behaviors and relationships based on mutual respect and affection, and free from violence, coercion, and intimidation;
• The development of meaningful relationships and avoidance of exploitative relationships;
• Understanding the influences of family, peers, community, and the media throughout life on healthy sexual relationships;
• Affirmative consent and recognizing and responding safely and effectively when violence or a risk of violence is or may be present, with strategies that include bystander training;
• Age-appropriate information about the legal elements of sexual [sex] offenses (under chapter 9A.44 RCW) where a minor is a victim, and the consequences upon conviction (per RCW 28A.300.145).

Affirmative consent as defined in RCW 28A.300.475 is an approach to giving and receiving consent that includes enthusiastic, "conscious and voluntary agreement to engage in sexual activity as a requirement before sexual activity." It is not just the absence of “no.” Since the law also says that instruction must be age-appropriate and most 4th and 5th-grade students are not engaged in sexual activity, age-appropriate instruction might focus on hugs or horseplay, hand-holding, kissing or other touch, as well as virtual contact such as texts or emails or taking photos. Instruction in these grades does not need to address sexual behavior unless the district has decided to do so for a specific reason (e.g. 6th-grade Healthy Youth Survey data that suggests a need). Bystander training teaches students how to safely intervene when they see bullying, sexual harassment, or unwanted physical touch. These topics are included in this legislation as a way for schools to combat the high rates of unwanted sexual contact experienced by youth in our state.

By August 31 of each year, all schools must report annually to OSPI on the following:

• Identify any curricula used to provide comprehensive sexual health education during the current/most recent school year
• Describe how classroom instruction aligns with the requirements of RCW 28A.300.475

To assist schools in meeting this requirement, OSPI has provided the CSHE Reporting Survey and are encouraged to submit their reports by June 30 each year for the current/most recent school year. A printable version of the CSHE Reporting Survey is available to support the collection of information needed for survey completion.

Beginning after the 2022-23 school year, OSPI must summarize and report the results of the school reports to the legislature biennially.

Requirements by Grade Band

• Grades 9-12

Schools must provide comprehensive sexual health education no later than 5th grade. Instruction must be consistent with Health Education K-12 Learning Standards . Grade-level outcomes are provided as examples only and do not represent a required course of instruction.

Required topics of instruction are described in RCW 28A.300.475 . Instruction should include a focus on helping students understand and respect personal boundaries, develop healthy friendships, and gain a basic understanding of human growth and development. Currently required HIV/STD prevention instruction will continue to be required.

Instruction must be provided at least “once” (a unit of instruction in at least one grade), including the following topics of instruction:

• HIV/STD prevention (required annually starting no later than grade 5).
• Human growth and development.
• Affirmative consent (understanding and respecting personal boundaries).
• Bystander intervention (how to safely intervene when witnessing bullying, harassment, or sexual violence).
• Healthy relationships (with friends and family).
• How to avoid exploitative relationships.

Schools must provide comprehensive sexual health education at least twice in grades 6-8. Best practice suggests providing instruction over time, building on earlier instruction. Instruction must be consistent with Health Education K-12 Learning Standards . Grade-level outcomes are provided as examples only and do not represent a required course of instruction.

Required topics of instruction are described in RCW 28A.300.475 , with a focus on helping students understand and respect personal boundaries, develop healthy friendships and dating relationships, gain a deeper understanding of human growth and development, develop skills to support choosing healthy behaviors, and reduce health risks, including abstinence and other STD/pregnancy prevention approaches, and understanding the influence of family and society on healthy sexual relationships. Students must receive age-appropriate instruction on affirmative consent and bystander training. Schools must continue providing HIV/STD prevention education, which must start no later than 5th grade and be provided annually through 12th grade.

Instruction must be provided at least “twice” (a unit of instruction in two or more grades). Ideally, this would be a unit of instruction in at least two different grades, and there are many possible strategies for providing all required content. Learning standards will help districts determine how to scaffold instruction to meet changing developmental needs across grades, which should include the following topics of instruction at least once in this grade band:

• HIV/STD prevention (required annually).
• Choosing healthy behaviors and reducing health risks (including abstinence, condom use, and contraceptives).
• Affirmative consent (understanding and respecting personal boundaries, including sexual boundaries).
• Healthy relationships (with friends, family, and dating relationships).
• Understand the influence of family, peers, community, and media on healthy sexual relationships.
• How to avoid exploitative relationships and the consequences of sexual offenses involving minors.

Schools must provide comprehensive sexual health education at least twice in grades 9-12. Ideally, this would be a unit of instruction in at least two different grades, and there are many possible strategies for providing all required content. Best practice suggests providing instruction over time, building on earlier instruction. Instruction must be consistent with Health Education K-12 Learning Standards . Grade-level outcomes are provided as examples only and do not represent a required course of instruction.

Required topics of instruction are described in RCW 28A.300.475 , with a focus on helping students understand and respect personal boundaries, develop healthy friendships and dating relationships, gain a deeper understanding of human growth and development, develop skills to support choosing healthy behaviors and reduce health risks, including abstinence and other STD/pregnancy prevention methods, how to access valid health care and prevention resources and understanding the influence of family and society on healthy sexual relationships. Students must receive age-appropriate instruction on affirmative consent and bystander training. Schools must continue providing HIV/STD prevention education, which must start no later than 5th grade and be provided annually through 12th grade.

• Human growth and development refresher.
• How to identify and access valid health care and prevention resources.
• Healthy Relationships (with friends, family, and dating relationships).

Materials & Resources

• Comprehensive Sexual Health Education FAQ Updated 10/12/21 (see Parent/Guardian Resources below for translated versions)
• K-3 Social Emotional Learning FAQ 12/30/2021
• RCW 28A.300.475
• WAC 392-410-140 (not yet updated to reflect new requirements of RCW 28A.300.475)
• RCW 28A.300.145 (age-appropriate information about sexual offenses)
• Youth at Risk – The Need for Sexual Health Education in Schools (OSPI Research Brief, 2019)
• Health Impact Review of ESSB 5395 (Washington State Board of Health, 2019)
• New Requirements for Comprehensive Sexual Health Education (B092-20) 12/18/2020
• 2023 Comprehensive Sexual Health Education Reporting Requirements (B028-23) 05/19/2023
• Comprehensive Sexual Health Education by Grade Band 03/11/2022
• A Guide to Sexual Health Education Implementation in Washington State 06/14/2022
• Guidelines for Sexual Health and Disease Prevention 01/13/2005
• CSHE Implementation Webinar , 12/17/2020
• Model Policy #2125, Sexual Health Education– contact WSSDA
• Model Policy #2126 , HIV-AIDS Prevention Education, is available for district use (WSSDA)
• Cardea Services , a non-profit based in Seattle, provides comprehensive sexual health education resources and technical assistance through the WA PREP for Healthy Youth project, with funding from the WA Dept. of Health.

Schools may use curricula and other instructional materials that have been reviewed by OSPI and the state Department of Health (DOH) for consistency with these provisions of the law or may choose to develop and/or review materials themselves with OSPI-developed review tools. OSPI does not approve or develop curriculum.

Curriculum, instruction, materials, and guest speakers must be medically and scientifically accurate, and consistent with the provisions outlined in the law.

Curriculum, instruction, materials, and guest speakers must be inclusive, using language and strategies that recognize all members of protected classes (see HIV and Sexual Health Education Resources).

Districts conducting their own reviews of sexual health education materials (rather than using OSPI-reviewed materials) must use OSPI-developed instructional materials review tools to ensure that materials meet requirements. Note: All review instruments have been updated to reflect the requirements of RCW 28A.300.475.

District Resources

• Sexual Health Education Instructional Materials

Parent/Guardian Notification and Materials

Parents and guardians must be notified at least one month in advance of planned instruction, must be able to review all CSHE instructional materials, and must be given the opportunity to opt their child out of CSHE instruction. Parents/guardians do not need to review instructional materials to opt their child out of CSHE instruction. However, if parents/guardians wish to opt their child out of HIV/AIDS prevention instruction specifically, they are required by the AIDS Omnibus Act (RCW 28A.230.070) to preview those instructional materials prior to opting their child out of HIV/AIDS prevention instruction.

• Sample Letter for Parents and Guardians Regarding CSHE Requirement—English | Russian | Spanish | Ukrainian .
• Combined HIV/SHE Parent Notification Letter—English | Arabic | Chinese | Korean | Russian | Somali | Spanish | Ukrainian | Vietnamese .
• Sample SHE Instruction Parent Waiver
• Sample HIV Instruction Parent Letter
• Sample HIV Instruction Parent Waiver
• Comprehensive Sexual Health Education FAQ Updated 10/12/21 (Earlier version of the FAQ also available in Russian | Spanish | Ukrainian | Vietnamese ).
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Sex Ed in Schools: What Parents Need to Know

Comprehensive sex education can help reduce rates of sexually transmitted infections and promote healthy relationships.

What to Know About Sex Ed in K-12 Schools

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Sex education in schools can be taught by a classroom teacher, school nurse or an outside speaker, and often begins in fifth grade.

For some parents, the term "sex ed" conjures memories of dated videos and cringe-inducing lessons on puberty or how babies are made.

But a good school-based sex education curriculum should be much more than that, encompassing multiple issues related to human growth and development, experts say. In addition to basic facts about puberty, sex and contraception, lessons can cover topics like healthy relationships, sexual violence prevention, body image, sexual orientation and gender identity.

"Just because you teach a young person about how to stay safe and what sex and sexuality is, you're not encouraging them to become sexually active," says Michelle Slaybaugh, director of social impact and strategic communications at SIECUS: Sex Ed for Social Change , a national group that advocates for inclusive sex education. "You're giving them the tools to make decisions about their bodies and their lives that best suit them as individuals."

Why Sex Education Matters

Research shows that comprehensive, culturally responsive and inclusive sex education programs help prevent intimate partner violence and help young people develop healthy relationships. These programs have also been shown to reduce rates of sexual activity, sexual risk behaviors, adolescent pregnancy and sexually transmitted infections.

Sex ed "promotes healthy behaviors," says Laurie Dils, associate director of content, health and sexual health education at the Washington Office of Superintendent of Public Instruction. "That's really what we are aiming for as educators, equipping young people with education and skills so that they can make healthy decisions that fit with their own values and their family's values."

But in public school, the quality of sex education your child will receive – or whether they will receive any at all – depends largely on the state and district you live in. There are no federal guidelines for sex education, and currently only 18 states require program content to be medically accurate, according to recent data from the Guttmacher Institute, a research and policy organization focused on sexual health and reproductive rights.

"Most young people have access to the internet," Slaybaugh says. "So if we are not providing them instruction that is medically accurate and age-appropriate, we are leaving it to chance for them to find something on the internet, i.e., porn, and then they think that's what sex and sexuality is."

Sex Education Requirements by State

Sex education standards vary by state – with some not having any curriculum requirements in schools. As of June 2022, 39 states plus Washington, D.C., mandate sex education, HIV education or both, according to Guttmacher Institute data.

Unlike sex education, HIV and STI instruction only focus on concepts like pregnancy prevention and risk reduction. "But sexuality touches our lives in so many other ways, especially when it comes to being inclusive to diverse people, families and experiences," Slaybaugh says.

Thirty-nine states and D.C. either stress or require abstinence to be covered when sex education is taught. Meanwhile, only 20 states require provision of information on contraception, Guttmacher Institute research found.

Slaybaugh says that abstinence-only teachings, sometimes referred to as sexual risk avoidance, are often "rooted in shame." For example, she points to one common lesson in which youth are asked to chew up gum and spit it out, then told the chewed up gum is a representation of a person who had sex before marriage.

"Abstinence-only programs do not teach communication and negotiation for consent," she adds. "It does not teach about what healthy relationships should look like and what they don't look like. They do not include affirming lessons around LGBTQIA+ individuals. They're ostracizing a large part of the youth population."

Health experts including the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that sex education include information about gender and sexual orientation. But only a small handful of states – 10 plus D.C. – require inclusive content with regard to sexual orientation.

Meanwhile, five states – Alabama, Louisiana, Oklahoma, South Carolina and Texas – allow only negative information to be shared about homosexuality and place a positive emphasis on heterosexuality, according to Guttmacher Institute data. And recently, some states have banned or are seeking to ban the discussion of sexual orientation and gender identity in school, especially in the younger grades.

Florida Governor Ron DeSantis, for example, signed a bill in March 2022 prohibiting instruction about sexual orientation or gender identity in K-3 classrooms. Chris Sprowls, speaker of the Florida House of Representatives, said in a press release that such instruction "does not belong in the classroom where 5- and 6-year-old children are learning. It should be up to the parent to decide if and when to introduce these sensitive topics."

But "not seeing yourself reflected at any time is always detrimental to young people. Certainly seeing yourself negatively portrayed would be devastating," says Stephanie Hull, president and CEO of Girls Inc., a nonprofit youth development organization. "When we don't have an LGBTQ inclusive health curriculum, then we don't reduce homophobic attitudes, we don't reduce the bullying and we don't reduce harassment. Those students are already unsafe, so it increases their lack of safety."

Curriculum by Age

Sex education in schools can be taught by a classroom teacher, school nurse or an outside speaker, and often begins in fifth grade, according to Dils.

But some experts say age-appropriate instruction should begin earlier. For instance, the National Sex Education Standards developed by SIECUS: Sex Ed for Social Change, Answer and Advocates for Youth, a group that works to advance sex education, say that sex education should begin in kindergarten . Based on those standards, early conversations are not about the act of sex, but cover basic information about male and female anatomy and concepts like consent and personal boundaries.

From kindergarten to third grade, curricula may also include lessons to help children understand their own emotions and develop good communication skills, boundaries and respect for others, Dils says.

Then, in third to fifth grade, curriculum can shift to discussing what healthy friendships look like. "If a young person doesn't know how to identify an unhealthy friendship, how can we assume that they will be able to identify and find a healthy romantic relationship later on?" says Slaybaugh.

Additionally, schools should start preparing students for puberty, to help them understand what's going to happen as they get older. The first questions that typically arise from children are: Am I normal? Are these changes that are happening to me normal?

"A big part of sex education, if it's done well, is just helping to normalize what they're going through and to give them enough understanding and tools so that they can manage whatever they're going through," Dils says. "It's different for every young person."

As students enter middle school and high school, discussions should dive deeper into puberty, romantic relationships, partner violence, STIs, gender orientation and sexual identity, experts advise.

Parent Involvement in Sex Education

Currently 40 states plus D.C. require school districts to involve parents in sex education and/or HIV education. Thirty-six states and D.C. give parents the option to remove their child from instruction, while five states require parental consent for students to participate in a program, according to recent data from the Guttmacher Institute.

Critics claim that comprehensive sex education oversexualizes children and is not age-appropriate. American Life League, a Catholic pro-life organization, states on its website that "because of sex education programs, schools have been taking away the parents’ responsibilities of teaching their child about human sexuality."

But proponents of comprehensive sex say parents should be involved. "Parents are the most influential people in an adolescent's decisions about sexuality, and we encourage family discussions about their values related to sexuality," Tazmine Weisgerber, training and technical assistance manager at Answer, a national nonprofit housed within Rutgers University that aims to promote access to comprehensive sex education for youth, wrote in an email.

Experts advise parents to find out what's being taught in the classroom and express any concerns about their child's program to administrators at the school or within the district. Issues can also be brought up during their local school board meetings.

Additionally, start having conversations around sex education with your children at home at an early age. Familiarize yourself with the subject by reading the National Sex Ed Standards, Slaybaugh says. There are many other resources parents can refer to, including:

• Planned Parenthood
• SEICUS: Sex Ed for Social Change
• Talk With Your Kids

"At the end of the day, I think all sex educators want parents to be involved," Slaybaugh says. "We want to help parents understand that this is not a scary subject and it's just as important as math, science or reading. It takes all of us to participate in the process to be successful at seeing sex ed as an important lesson."

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The Sex Ed. Battleground Heats Up (Again). Here’s What’s Actually in New Standards

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When Judy LoBianco first started teaching health education decades ago, she leaned into what she called the “shock value.”

LoBianco, now the supervisor of health and physical education for the Livingston public schools in New Jersey, remembers showing students videos of childbirth and the movie “Super Size Me,” a 2004 documentary about the negative health effects of fast food.

Over the past couple of decades, though, best practice has shifted, LoBianco said—away from trying to scare kids off behavior that carries any risk and toward an approach that emphasizes decisionmaking, risk management, and self-advocacy.

“It’s about building skills and giving them practice,” LoBianco said. “Because when kids feel confident in their skills, they’ll act in more healthy ways.”

But two states that have updated their standards to reflect this research-based shift are now facing pushback from a vocal group of critics.

In Illinois and New Jersey , where changes to health and sex education standards are rolling out this school year, the revisions have sparked outbreaks of fierce, pointed controversy—a backlash that sex education experts say targets LGBTQ youth and deliberately mischaracterizes the standards and their aims.

At school board meetings in New Jersey districts, opponents of the new standards have claimed that they show young children “sexually explicit” material and are “indocrinating” kids into “woke ideology.” In May, several members of the state board of education called for the standards to be reevaluated , a request that the full board and the acting education commissioner denied.

In Illinois, where districts are not required to provide comprehensive sex education, many school systems have chosen not to adopt the new standards.

Over the past year, the outcry has become a talking point for Republican politicians in these states and a headline issue for national conservative media outlets, which have denounced the standards’ gender inclusivity, contending that they introduce children to age-inappropriate material.

This is a moral panic that comes whenever society moves away from this patriarchal, Christian, white supremacist view of the way the world should be.

In a sense, this is a familiar story. Pitched debate about the scope of health classes isn’t a new phenomenon, said Nora Gelperin, the director of sex education and training at Advocates for Youth, a group that works for adolescent sexual and reproductive health.

Gelperin was one of the writers of the National Sex Education Standards , which Illinois has adopted. The national standards also influenced New Jersey’s guidelines.

But now, the focus of this pushback has shifted more forcefully toward anti-LGBTQ rhetoric, she said.

Sex education advocates linked this resistance to the anti-LGBTQ legislation that at least 15 states have considered or passed this legislative session . The most well-known of these laws, Florida’s, prevents teachers from instructing K-3 students about gender or sexuality. Other proposed legislation would limit how teachers can use students’ pronouns, restrict use of materials featuring LGBTQ characters or themes, or regulate clubs for LGBTQ students.

And the outrage about sex education has once again put a spotlight on schools’ instructional choices, a situation that some advocates fear could make educators hesitant to address certain topics altogether.

“I have no problem with someone deciding for their own child, but when you get out there and start hijacking the narrative for everyone else’s kid, that’s dangerous,” said LoBianco.

A shift from risk prevention to a more proactive approach

The changes in Illinois and New Jersey are part of an evolution in the field of sex education, said Eva Goldfarb, a professor of public health at Montclair State University. Goldfarb contributed to the most recent version of the National Sex Education Standards, published in 2020.

The guidelines were developed by the Future of Sex Education Initiative, a partnership between three groups that support comprehensive sex education: Advocates for Youth, Answer, and SIECUS: Sex Ed for Social Change. This version is an update from the 2011 edition, which 41 percent of school districts said they’d adopted as of 2016 .

In the 1980s and early ‘90s, the big debate in schools was whether teachers should take an abstinence-only approach or whether they should provide information about how to avoid pregnancy and sexually transmitted infections, Goldfarb said.

In response to the HIV/AIDS epidemic, sex education advocates pushed for and won state-level mandates for prevention education, Goldfarb said.

Still, abstinence-only education has a strong foothold in U.S. schools. The federal government has offered funding for abstinence-only sex education since the 1990s , and funding levels increased during the Trump administration.

But research shows that when schools broaden the scope of sex education classes beyond abstinence or risk prevention—to discuss gender roles and identity, normalize sexual diversity, and focus on social and emotional skills—students can see better outcomes. A research review by Goldfarb and her colleague Lisa Lieberman of 30 years of studies found that this kind of approach—now generally known as comprehensive sex education—can lower anti-LGBTQ bullying, improve the skills that support healthy relationships, and reduce intimate partner violence.

“The goal is helping people to have the important, functional knowledge and skills and attitudes to make healthy decisions for themselves, to appreciate and enjoy their own bodies and sexuality, and to appreciate and respect the bodies of others as well,” Goldfarb said.

What does that mean in practice? Take a few examples from the National Sex Education Standards.

The standards still require schools to provide information about how to mitigate risk. By the end of 8th grade, for example, students should be able to identify different forms of contraception and STI prevention as well as develop a plan for eliminating or reducing the risks of sexual activity.

But the standards also aim to teach students how to seek out information and how to develop their own values. Eighth graders are expected to know how to find medically reliable sources on these topics and to identify factors that are important in deciding whether and when to engage in sexual behaviors.

A classroom assignment might ask students to practice research skills that they’ve learned, said LoBianco . For example, she said, she might divide students into groups and assign each to research a different sexually transmitted infection. As they conduct their research, students would have to evaluate the reliability of the sources they find.

The national standards spiral, covering topics like consent and healthy relationships, anatomy and physiology, gender identity and expression, and sexual health throughout successive grade levels. But that doesn’t mean that topics like STIs, sexual identity, and sexual violence are introduced right away.

Instead, the standards aim to build knowledge and skills sequentially. In 2nd grade, for instance, the national standards require that students can list medically accurate names for the body parts, including genitals, and that students can define “bodily autonomy” and personal boundaries.

The standards are learning goals—what students should know and be able to do. Districts and schools select, create, or purchase the curriculum and lessons they use to convey them.

Anti-LGBTQ groups spread ‘hysteria’ about gender identity

Most parents have historically supported sex education that covers these kinds of topics.

In a 2017 survey of Democrats and Republicans , about 90 percent of parents supported classes that cover healthy relationships, STIs, birth control, and abstinence in high school; 78 percent of parents supported these subjects covered in middle school.

Parents in a 2012 study were less sure about elementary sex education but still mostly positive: About 90 percent were in favor of instruction on communication skills, about 65 percent supported anatomy instruction, and about 52 percent supported instruction about gender and sexual identity.

Now, a vocal group of parent activists and commentators has commandeered the national conversation. They claim that schools are “grooming” young children by discussing LGBTQ identity and providing information about sexual health.

The term “grooming” refers to the behavior of sexual predators, who develop inappropriately close relationships with child victims in order to isolate them and reduce the chance that they will report incidents. But as Education Week reported earlier this year , some conservative commentators have weaponized the word to falsely equate discussions about LGBTQ identity with sexual abuse, a development sociologists and others warn is dangerous.

In a recent C-SPAN interview , Tina Descovich, the co-founder of the right-wing group Moms for Liberty, said that the biggest concern reported from local chapters was “the oversexualization of children.”

“The National Sex Education Standards right now, they actually say in K-3 that they want to teach gender ideology, that children … by the time they reach 7 years old, should be able to understand completely that they could be a boy, or a girl, they could be neither or both. And a lot of parents just don’t want that discussed with their youngest children,” Descovich said.

But experts stressed that this is a misreading and that conversations about gender aren’t inherently sexual in nature.

Kids have 24/7, 365 access to information about their sexual health, and if no adult is intervening or providing info, they’re going to seek out information.

The national standards say that 2nd graders should be able to “define gender, gender identity, and gender-role stereotypes,” as well as discuss how people express their gender and how stereotypes might limit behavior. In 5th grade, students are expected to “demonstrate ways to promote dignity and respect for all people.”

What this means in practice, said Goldfarb, is that teachers might explain to the youngest children that there aren’t “girl toys” or “boy toys” and that however kids want to express themselves is OK. The message, she said, is “we all get to feel good about ourselves and our bodies as we are.”

She attributes the “hysteria” she says activists are creating around gender identity to deeper fears about changing social mores and expansions of rights. “This is a moral panic that comes whenever society moves away from this patriarchal, Christian, white supremacist view of the way the world should be,” Goldfarb said.

Parents also regularly cite concerns about language and definitions, said Advocates for Youth’s Gelperin. For example, the national standards require that by 2nd grade, students know the medically correct terms for their genitals. By 8th grade, students should be able to define vaginal, oral, and anal sex.

“I think there’s this worry that if we say the words like ‘penis’ and ‘vulva’ and ‘anus,’ that’s going to be damaging for kids. And that’s just not the case,” Gelperin said. In fact, research suggests that teaching students accurate terms can help prevent child sexual abuse.

And standards for older students, on defining vaginal, oral, and anal sex, aren’t about providing a how-to guide, said LoBianco. Rather, the idea is to give students accurate information from a trusted source so that they’re not relying on Google searches and social media.

“Kids have 24/7, 365 access to information about their sexual health, and if no adult is intervening or providing info, they’re going to seek out information,” LoBianco said.

How some schools are approaching these changes

In LoBianco’s state of New Jersey, only a handful of districts have publicly opposed the standards. Sex education is mandatory, and department of education officials have said that they will penalize districts that don’t teach a curriculum that aligns to the new standards.

But some districts have put in place workarounds.

The East Hanover school district said that it plans to include some new lessons to meet the standards—but they’ll all be taught on the last day of school, according to local news reports .

And while all districts in the state must let parents opt students out of any sex education lessons, the Middletown Township school system is planning to require parents to opt in.

Considering all the controversy “swirling around,” the district wanted to be as transparent as possible with parents, said Kate Farley, the curriculum committee chair on the Middletown board of education.

In April, New Jersey state Sen. Holly Schepisi, a Republican, posted some sample materials on Facebook, saying that “some go so far as unnecessarily sexualizing children further.” The post ignited a media firestorm and brought fresh pushback from GOP state lawmakers.

It illustrated the confusion between standards and curriculum: The lesson plans Schepisi posted aren’t mandatory.

And in Middletown, parents and community members thought that some of the lessons they’d seen would be required. Or, Farley said, they had heard that there was a specific “gender lesson” in 2nd grade or that the district was planning to teach kindergartners about sex. None of that is true, said Farley.

So, the district selected a set of materials for K-5 and posted all of them online for parents to review. “What you see is exactly what you get,” Farley said. “There’s just no room for any sort of question about what their child will be exposed to.”

Given this intense scrutiny and social-media misinformation, Gelperin suggested that schools take a similar approach to transparency, and make information about what curriculum they’ll be using readily available.

Schools can also hold family nights when parents can come in to look at materials and ask questions, she said.

Teachers and school leaders can always come back to the “why,” said LoBianco—that schools are giving students information and skills that they can use to protect themselves and feel confident in their identities.

“When you explain this to the most reasonable of parents, then they start to understand,” LoBianco said. “If there’s one thing that parents want their children to be, it’s healthy and safe.”

A version of this article appeared in the September 07, 2022 edition of Education Week as The Sex Ed. Battleground Heats Up (Again). Here’s What’s Actually in New Standards

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Rights, respect, responsibility, a k-12 sexuality education curriculum., honest, inclusive sex education for all students.

Rights, Respect, Responsibility is a sex education curriculum that fully meets the National Sexuality Education Standards and seeks to address both the functional knowledge related to sexuality and the specific skills necessary to adopt healthy behaviors. Rights, Respect, Responsibility reflects the tenets of social learning theory, social cognitive theory and the social ecological model of prevention. Check out this 2022 Teacher's Guide Supplement for Students with Physical Disabilities.

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Fully meets the National Sexuality Education Standards

CA Healthy Youth Act Aligned Version Available

Been through a SHECAT Curriculum Review

Covers all 16 topics recommended by the Centers for Disease Control and Prevention (CDC) as essential components of sexual health education

Inclusive for issues related to sexual orientation and gender identity

Affordable (Free)

Flexible K-12 curriculum

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Resources for educators at every grade level

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The Science of 3Rs

Rights, Respect, Responsibility builds on 30 years of research into effective sexuality education programs, while respecting young people’s right to the information they need to protect their health and make responsible decisions.

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

Usable Knowledge

Connecting education research to practice — with timely insights for educators, families, and communities

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The State of Sex Education

Dr. Ruth Talks Sex and Ed

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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.

Last Updated

American Academy of Pediatrics

Summary State Policies on Sex Education in Schools

Why is sexual education taught in schools.

A 2017 Centers for Disease Control and Prevention (CDC)  survey  indicates that nearly 40 percent of all high school students report they have had sex, and 9.7 percent of high school students have had sex with four or more partners during their lifetime. Among students who had sex in the three months prior to the survey, 54 percent reported condom use and 30 percent reported using birth control pills, an intrauterine device (IUD), implant, shot or ring during their last sexual encounter.

The birth rate for women aged 15-19 years was  18.8 per 1,000 women  in 2017, a drop of 7 percent from 2016. According to CDC, reasons for the decline are not entirely clear, but evidence points to a higher number of teens abstaining from sexual activity and an increased use of birth control in teens who are sexually active. Though the teen birth rate has declined to its lowest levels since data collection began, the United States still has the highest teen birth rate in the industrialized world.

Certain social and economic costs can result from teen pregnancy. Teenage mothers are less likely to finish high school and are more likely than their peers to live in poverty, depend on public assistance, and be in poor health. Their children are more likely to suffer health and cognitive disadvantages, come in contact with the child welfare and correctional systems, live in poverty, drop out of high school and become teen parents themselves. These costs add up, according to The National Campaign to Prevent Teen and Unplanned Pregnancy, which estimates that teen childbearing costs taxpayers at least $9.4 billion annually. Between 1991 and 2015, the teen birth rate dropped 64%, resulting in approximately  $4.4 billion  in public savings in one year alone.

Sexually transmitted infections (STIs) disproportionately affect adolescents due to a variety of behavioral, biological and cultural reasons. Young people ages 15 to 24 represent  25 percent  of the sexually active population, but acquire half of all new STIs, or about 10 million new cases a year. Though many cases of STIs continue to go  undiagnosed and unreported , one in four sexually-active adolescent females is reported to have an STI.

Human papillomavirus  is the most common STI and some estimates find that up to 35 percent of teens ages 14 to 19 have HPV. The rate of reported cases of chlamydia, gonorrhea, and primary and secondary syphilis increased among those aged 15-24 years old between 2017-2018. Rates of reported chlamydia cases are consistently highest among women aged 15-24 years, and rates of reported gonorrhea cases are consistently highest among men aged 15-24 years. A CDC analysis reveals the annual number of new STIs is roughly equal among young women and young men. However, women are more likely to experience long-term health complications from untreated STIs and adolescent females may have increased susceptibility to infection due to biological reasons.

The estimated direct medical costs for treating people with STIs are nearly $16 billion annually, with costs associated with HIV infection accounting for more than 81% of the total cost. In 2017, approximately  21 percent  of new HIV diagnoses were among young people ages 13 to 24 years.

Sex Education and States

All states are somehow involved in sex education for public schoolchildren.

As of October 1, 2020:

• Thirty states and the District of Columbia require public schools teach sex education, 28 of which mandate both sex education and HIV education.
• Thirty-nine states and the District of Columbia require students receive instruction about HIV.
• Twenty-two states require that if provided, sex and/or HIV education must be medically, factually or technically accurate. State definitions of “medically accurate" vary, from requiring that the department of health review curriculum for accuracy, to mandating that curriculum be based on information from “published authorities upon which medical professionals rely.” (See table on medically accuracy laws.)

Many states define parents’ rights concerning sexual education:

• Twenty-five states and the District of Columbia require school districts to notify parents that sexual or HIV education will be provided.
• Five states require parental consent before a child can receive instruction.
• Thirty-six states and the District of Columbia allow parents to opt-out on behalf of their children.

*Medical accuracy is not specifically outlined in state statue, rather it is required by the New Jersey Department of Education, Comprehensive Health and Physical Education Student Learning Standards.

** Medical accuracy requirement is pursuant to rule R277-474 of the Utah Administrative Code.

***Medical accuracy is not outlined in state statute, rather it is included in the Virginia Department of Education Standards of Learning Document for Family Life Resources.

Source: NCSL, 2019; Guttmacher Institute, 2019; Powered by StateNet

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Sex Education in School, are Gender and Sexual Minority Youth Included?: A Decade in Review

Comprehensive sexual health education increases sexual health knowledge and decreases adverse health outcomes and high-risk behaviors in heterosexual youth but lacks information relevant to gender and sexual minority youth. Universal access to comprehensive sexual health education that includes information relevant to gender and sexual minority individuals is lacking in the United States, leading to poor health outcomes for gender and sexual minority youth. The purpose of this review was to examine sexual health education programs in schools in the United States for the inclusion of information on gender identity and sexual orientation. The review provides information on current programs offered in schools and suggestions to make them more inclusive to gender and sexual minority youth.

Is Sex Education for Everyone?: A Review

Gender and sexual minority youth (GSMY), youth who do not identify as heterosexual or their gender identity are non-binary, have increased sexual risk behaviors and adverse health outcomes compared to their heterosexual and cisgender peers ( Kann et al., 2016 ; Rasberry et al., 2017 , 2018 ). According to the 2017 YRBS youth that identified as a sexual minority (lesbian, gay, bisexual, or another non-heterosexual identity or reporting same-sex attraction or sexual partners) reported increased sexual partners, earlier sexual debut, the use of alcohol or drugs before sex, decreased condom and contraceptive use than their heterosexual peers ( Rasberry et al., 2018 ). Comprehensive sexual health education increase sexual health knowledge and decreases adverse health outcomes, sexually transmitted infections (STIs), HIV, and pregnancy and high-risk behaviors in heterosexual youth, age of sexual initiation, the number of sex partners, sex without protection, sex while under the influence of drugs and alcohol ( Bridges & Alford, 2010 ; Mustanski, 2011 ; Sexuality Information and Education Council of the United States (SIECUS)., 2004 ; Steinke et al., 2017 ). Research conducted with heterosexual adolescents shows comprehensive sexual health education, medically accurate material that includes information on STIs, HIV, pregnancy, condoms, contraceptives as well as abstinence and sexual decision making, increases sexual health knowledge and decreases adverse health outcomes, STIs, HIV, and pregnancy and high-risk behaviors ( Bridges & Alford, 2010 ; Mustanski, 2011 ; Sexuality Information and Education Council of the United States (SIECUS)., 2004 ; Steinke et al., 2017 ). Most GSMY report receiving some form of sexual health education in school ranging from comprehensive to abstinence-only, however GSMY-inclusive sexual health education, education that includes information on all genders and sexual orientations, is out of reach for a majority of youth in the United States ( Charest et al., 2016 ; Human Rights Campaign, 2015 ; Kosciw et al., 2018 ; Steinke et al., 2017 ). Not having access to GSMY-inclusive sex education, GSMY lack the information they need to understand their sexuality and gender concerns and to make informed sexual decisions ( Charest et al., 2016 ; Steinke et al., 2017 ).

Most teens, 70%, report receiving some form of sexual health education in school; while the content varies widely, from abstinence-only to comprehensive, it is primarily penile-vaginal in nature ( Human Rights Campaign, 2015 ; Lindberg et al., 2016 ). Universal access to comprehensive and GSMY-inclusive sexual health education is lacking in the United States and can lead to poor health outcomes for GSMY ( Human Rights Campaign, 2015 ). Currently, only 27 states mandate sexual health and HIV education ( Guttmacher Institute, 2020 ). Seventeen states require discussion of sexual orientation, with only 10 requiring information to be inclusive of gender and sexuality, and seven mandating only negative information be provided on homosexuality and positive information solely be provided on heterosexuality ( Guttmacher Institute, 2020 ). These laws intended to prohibit the promotion of homosexuality, deny SGMY the sexual health information they need and serve to further stigmatize them for their gender identity and sexual orientation ( Gay, Lesbian and Straight Education Network (GLSEN), 2018 ).

Significance of the Topic

Despite the effectiveness of comprehensive sexual health education in increasing sexual health outcomes in heterosexual youth, little research has been done on its effects on GSMY ( Human Rights Campaign, 2015 ; Kosciw et al., 2018 ; Steinke et al., 2017 ). The sex education offered in schools primarily describes penile-vaginal intercourse and does not include information on oral, anal, or manual intercourse or ways to practice safe sex with these types of sexual activity. Less than 7% of GSMY in the United States report receiving sexual health education that was inclusive of both gender and sexual minorities ( Charest et al., 2016 ; Human Rights Campaign, 2015 ; Kosciw et al., 2018 ; Steinke et al., 2017 ). Many GSMY look to the internet or pornography for information on sex, leading to misinformation or an unrealistic expectation of intercourse and relationships ( Arbeit et al., 2016 ; Charest et al., 2016 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Roberts et al., 2019 ).

Teens and young adults account for 21% of all new HIV cases in the United States, with 81% of newly diagnosed cases attributed to young men who have sex with men ( Centers for Disease Control and Prevention (CDC), 2019 ). Lindley & Walsemann, (2015) conducted a study of teens in New York and found that GSMY youth had between a two to seven times higher chance of being involved in a pregnancy than their heterosexual peers. According to the Centers for Disease Control and Prevention (2018) , young men who have sex with men have a higher incidence of gonorrhea, chlamydia, and syphilis compared to women and men who have sex with women only. The 2017 YRBS report revealed that GSMY reported significantly higher incidences of forced sex, dating violence, suicidal thoughts, attempted suicide, bullying, alcohol and drug use, earlier initiation into sex, more sexual partners, and were also less likely to use condoms during sexual intercourse than their heterosexual peers ( Kann et al., 2018 ; Rasberry et al., 2018 ). To improve sexual health outcomes in GSMY, they need to receive sexual health education that is comprehensive and inclusive to all genders and sexual orientations at an early age.

The purpose of this review was to examine the sexual health education programs in public and private schools in the United States for the inclusion of information on gender identity and sexual orientation. Further, this review provides an understanding of the sexual health education needs of GSMY, how it is reflected in the programs offered to young adults, and what changes could be made. A review of studies published between 2010 and 2020 was conducted to evaluate the inclusion of gender and sexual minority information in sexual health education offered in schools.

Literature Search

The review was conducted according to the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA) guidelines ( Moher et al., 2009 ). The search was conducted using three online databases: CINAHL, PubMed, and Scopus. The search strategy for CINAHL was as follows: limits were set to include research articles published in English in peer-reviewed academic journals, age restriction set to “all child” major heading “sex education” and “sexual health”. The search date was set from January 2010 to March 2020. The reason for the 2010 start date was to get the latest information on sexual health education programs. The combinations of the search terms used were “sex education” and “sexual minority”; “sexual health education” and “sexual minority”; “inclusive” and “sex education” and “school”; “LGBT” and “sex education”. The same searches were conducted in each of the other databases. The process is illustrated in Figure 1 . The initial searches yielded a total of 83 articles after duplicates were removed; 56 articles could be excluded after reading the title or abstract due to location or not discussing sex education in the primary or high school setting, 27 articles were viewed in full text. After reading the full-text articles, 14 articles were excluded for the following reasons: seven did not discuss sex education programs in school, five discussed program implementations, and two were not set in the United States. A total of 13 peer reviewed articles were included in this review ( Table 1 ).

PRISMA diagram showing search and screening process, and selection of studies for inclusion in the review.

Review of Studies Related to Inclusive Sexual Health Education

Current Education Offered

Heteronormative information.

A majority of the research reported the content of the sexual health education offered in schools was heteronormative, the belief that heterosexuality and binary gender are the norms, and the intercourse discussed was penile-vaginal intercourse ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Steinke et al., 2017 ). The lessons primarily consisted of information about puberty, the dangers of sex, penile-vaginal intercourse, STIs, and pregnancy; information the GSMY in the studies reported as irrelevant to them ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Roberts et al., 2019 ). Of the 13 studies, eight mentioned students being taught about external condoms, one mentioned internal condoms, 1 discussed students being shown a condom demonstration and none reported information being given on dental dams or finger condoms. ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Roberts et al., 2019 ). In seven of the studies, participants reported their questions regarding gender identity or sexual orientation went unanswered in class. This was due to the teacher ignoring the question, the teacher lacking the information to answer, or the teacher not being allowed to answer due to school and state policy ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Mahdi et al., 2014 ; Pingel et al., 2013 ; Steinke et al., 2017 ).

Supplying only heteronormative education contributed to poorer mental outcomes for GSMY. Non-heterosexual, non-binary, and gender-nonconforming individuals and their behavior were often pathologized in the education presented, leading to internalized homophobia, increased depression, increased anxiety, and self-loathing in GSMY ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Steinke et al., 2017 ). The exclusion of information about gender and sexual minorities made GSMY feel confused about how they were feeling, made them feel something was wrong with them and made them feel like they did not exist ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Roberts et al., 2019 ). Lack of GSMY-inclusive information also led to an increase in bullying of GSMY in schools from both students and teachers ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; W. J. Hall et al., 2019 ; McCarty-Caplan, 2015 ; Roberts et al., 2019 ). Numerous studies described a decrease in bullying of GSMY in schools with GSMY-inclusive education, potentially due to a normalizing non-heterosexual, non-binary, and gender-nonconforming individuals, ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Proulx et al., 2019 ; Roberts et al., 2019 ).

Incomplete and Inaccurate Information

The negative impact an incomplete sex education had on GSMY health was a common theme in the literature ( Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ). Many of the lessons taught in school only covered the “mechanics” of penile-vaginal intercourse and the problems that can occur from that action, with few reporting receiving lessons about other types of sex (anal, oral, manual, masturbation), healthy relationships, consent, or the enjoyment of sex ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Roberts et al., 2019 ). No studies reported information being taught on transgender identity, non-binary identity, or use of proper pronouns ( Haley et al., 2019 ; Hobaica et al., 2019 ; Roberts et al., 2019 ).

Several authors discussed inaccurate information being offered to students in schools ( Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ). Hobaica and Kwon (2017) reported in 2016 only 20 states required sexual health information provided to students in school to be medically accurate. Inaccurate information given to youth included inflated failure rates of condoms and birth control, inaccurate information on the transmission of STIs, and inaccurate representation of gender and sexual minority individuals ( Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Roberts et al., 2019 ; Steinke et al., 2017 ). Lack of information and inaccurate information contributed to GSMY making uninformed decisions about sex, leading to increased sexual experiences, increased number of partners, non-consensual sexual experiences, unprotected sex, sex while intoxicated, STIs, and pregnancy ( Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ).

Timing of Information

The timing of education being offered to students occurred in middle school and high school ( Bodnar & Tornello, 2019 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ). For some GSMY this information came too late to be helpful. Sexual minority youth report earlier initiation into sex and many received sex education after they had already become sexually active leading to early risky sexual behaviors and pregnancy ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Haley et al., 2019 ; Hobaica & Kwon, 2017 ). Gender minority and non-binary individuals recommended that information about gender and puberty start as early as 1 st and 2 nd grade to help with the problems associated with gender dysphoria.

Recommendations

There were many recommendations included in the literature on how to make sexual health education more inclusive and appropriate for GSMY. To be relevant to all students sexual health education must be inclusive of all genders and sexual orientations and it is important that affirming gender and sexuality inclusive language and pronouns are used when describing different subgroups of GSMY ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Rasberry et al., 2017 ; Roberts et al., 2019 ; Steinke et al., 2017 ). It is important that the education provided be medically accurate and cover different types of sex acts, not just penile-vaginal intercourse, include information on the type of protection needed to have safe sex based on the sexual act being performed, and local resources where it can be obtained ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Roberts et al., 2019 ). Education should also include information on medical and non-medical gender-affirming interventions, information on relationships, consent, and reputable resources for healthcare and sexual health information ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Roberts et al., 2019 ). There was a reported need for inclusion of historical gender and sexual minority individuals in the core curriculum. This would allow GSMY to have role models and would allow others could see gender and sexual minority individuals in a different light ( Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ).

This paper reviewed how sexual health education has been presented in schools over the past ten years. All studies reported participants receiving some form of sexual health education in school. However, the education presented was almost exclusively heteronormative and exclusive to GSMY needs leaving them feeling left out and lacking the information they needed to better understand themselves and make informed sexual health decisions ( Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ).

School administrators need to be aware of the specific sexual health needs of GSMY and tailor education to meet the needs of all the students, not only cisgender, heterosexual students. Providing comprehensive GSMY-inclusive education improves the physical and mental health outcomes of all youth and decreases bullying of GSMY in school ( Hobaica et al., 2019 , 2019 ; Human Rights Campaign, 2015 ; Proulx et al., 2019 ; Roberts et al., 2019 ). GSMY-inclusive education has been shown to decrease negative mental health outcomes and bullying by normalize the LGBT experience ( Gowen & Winges-Yanez, 2014 ; Proulx et al., 2019 ; Roberts et al., 2019 ) and potentially decrease pregnancy and STI rates, and increase the use of condoms and the age of sexual debut ( Haley et al., 2019 ; Hobaica et al., 2019 ; Pingel et al., 2013 ). If school administrators are unable to provide GSMY-inclusive sex education due to policy at the local or state level, it is important to offer vetted outside resources for students and to work with politicians to change these stigmatizing laws ( W. J. Hall et al., 2019 ; Human Rights Campaign, 2015 ; Steinke et al., 2017 ).

The needs of students should take precedent when creating sexual health education programs. Administration, faculty, and staff should be educated on the needs of GSMY. Curricula presented to students in schools must be evidence-based and facilitated by trained LGBT (lesbian, gay, bisexual, and transgender) affirming educators ( Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Human Rights Campaign, 2015 ; Steinke et al., 2017 ).

Limitations

This review is not without limitations. The search databases used were health and medical and not educational in nature due to the author examining the physical and mental health aspects of sex education on GSMY. The number of articles included was small and more may have been included had educational databases been used. MeSH terms were not used in the search as they had a limiting effect on the results. Lastly, there is very little research on the long-term benefits of GSMY-inclusive sex education in the United States. One of the reasons for this is there is no consistent sex education offered to students, with instructional content often being based on state, local, mandate or teacher preference.

This review indicated that schools are still presenting sexual health education exclusive of gender and sexual minority needs. Sex education is a public health necessity, allowing individuals to make informed decisions concerning their sexual health and wellbeing, and GSMY are being overlooked, leading to poorer mental and physical health outcomes ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Roberts et al., 2019 ). Sex education in schools needs to be medically accurate, affirming, and reflect all genders and sexual orientations to help reduce health disparities and increase the quality of life for GSMY. Future research should focus on strategies to implement comprehensive and GSMY-inclusive sex education in schools to evaluate its impact on the health and wellness of all youth.

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Public Health

Texas got a sex ed update, but students and educators say there's still a lot missing.

Elena Rivera

J.R. Chester, an advocate with the Texas Campaign to Prevent Teen Pregnancy, says she hopes the state's updated sex education curriculum will lead to more open conversation between parents and kids. Keren Carrión/KERA hide caption

J.R. Chester, an advocate with the Texas Campaign to Prevent Teen Pregnancy, says she hopes the state's updated sex education curriculum will lead to more open conversation between parents and kids.

Cali Byrd is a junior at Booker T. Washington High School in Dallas. She remembers when a group came to talk to her class about sexually transmitted infections in eighth grade.

The talk involved a bunch of tennis balls with the names of STIs written on them.

"They had a couple of kids come up, put on gloves, and said, 'If he throws the ball to her and she has a glove on, then she's protected. But if she doesn't have a glove on, then she'll get the disease or something,' " Byrd said. "It was really weird."

Byrd said the instructors never explained what the STIs were, just that people should wear condoms to prevent them. "It really was not helpful," she said.

That was the last time she got any sex education in school, Byrd said, as it's not mandatory once kids get to high school .

Instead, in 2020, Byrd started training to be a peer educator through Planned Parenthood of Greater Texas , where she learned details about STIs, and different methods of birth control. "It was a lot of catching up," she said.

After more than two decades, the Texas State Board of Education is finally catching up too. It has updated the health curriculum, including sexual health, for elementary and middle school students. The new curriculum, which will be taught starting in fall 2022, includes detailed information about birth control and STIs for the first time.

But it leaves out some key elements advocates wanted to see. And despite the state's high teen birth rate, a recent policy change by Texas leaders made sex education opt-in, rather than opt-out, which means some kids might not get any instruction in schools at all.

Working to normalize sexual health conversations

The new curriculum comes after years of work from organizations across Texas that are trying to mainstream conversations about sexual health.

"Your reproductive and sexual health is really important for your life," said Terry Greenberg, the founder of North Texas Alliance to Reduce Unintended Pregnancy in Teens . "Not only does it determine your personal health, it's the health of your family. If you're not giving kids that, you're not equipping them to be adults."

Teen birth rates across the country have been declining since 2007, according to the U.S. Department of Health and Human Services. But Texas is routinely in the top ten states with the highest teen birth rate, with 22.4 teen births per 1000 females aged 15-19, compared to California's rate of 11 per 1000, or Vermont's at 7 per 1000, according to 2019 data from the Centers for Disease Control and Prevention .

Advocates like Greenberg in Texas think better education about contraceptives and pregnancy prevention would help some of these statistics. Multiple research studies support this idea. Providing students with medically accurate and inclusive sexual health education can reduce unintended consequences like teen pregnancy and STIs.

"I mean, any unintended pregnancy is kind of on us," Greenberg said. "Why didn't we supply people with what they needed?"

The new curriculum is still abstinence-first, but including detailed information on contraceptives and STIs is a win for Greenberg and statewide advocates at the Texas Campaign to Prevent Teen Pregnancy.

An educator in Dallas holds an instructional device at the North Texas Alliance to Reduce Unintended Pregnancy in Teens. The group offers sex education to young people to equip them to be adults. Keren Carrión/KERA hide caption

An educator in Dallas holds an instructional device at the North Texas Alliance to Reduce Unintended Pregnancy in Teens. The group offers sex education to young people to equip them to be adults.

"These standards hadn't been updated since Titanic was out in theaters," said Jen Biundo, director of policy and data with the organization. "It had been a minute."

But the new curriculum still leaves things out. It does not include instruction on consent, gender or LGBTQ+ topics . Those omissions reflect a larger battle for control over what information kids can access, that's seen book bans , pride events and trans youth targeted by lawmakers.

There's also a new policy from the legislature that requires parents and caregivers to opt-in to health education, rather than opt-out . That means the default is that kids don't get taught about sexual health, puberty or reproduction, unless parents give permission. Texas leaders, including Gov. Greg Abbott, said parents should have control over what their children learn in schools.

Texas is now one of less than six states across the country with an opt-in policy .

Biundo said she's concerned that one missed piece of paper or email will mean that some kids won't get this instruction at all.

"When I think about the paperwork that I've fished out of my child's backpack three weeks late, this kind of terrifies me," she said.

"The big concern with the opt-in policy is that some kids will just slip through the cracks," Biundo said. "Maybe they're not living with a parent or guardian, or maybe they don't have a parent or guardian who's closely engaged. Those might be the kids that need this information the most."

Greenbert says opt-in policy is a "huge logistical barrier for kids." "Do you really care about the reproductive health of these kids? You have to give them information," she said.

Letting kids ask questions and learn, without shame

J.R. Chester has seen all this before. Slow updates and lack of information access has been a pattern since she started as a community health worker with Parkland Health Hospital System more than ten years ago.

"I was a repeat teen mom," Chester said. "Our oldest is 16. He is just a year younger than I was when I got pregnant with him. Then, after I gave birth to him, three months later, we were pregnant with number two."

The Dallas native said she doesn't remember anyone explaining to her what contraceptives were, or why she menstruated every month.

"No one took the time to tell me, this is why your body is doing this," Chester said.

Chester said her work is to make sure that kids can ask questions, without shame or guilt.

There are still a lot of myths about health and reproduction that Chester works to debunk, even with adults.

"A lot of my female students had no idea that sexual intercourse didn't take place in the same hole that they urinated from," said Chester. "They had this myth in their mind that oh, well, can't you just pee it out? I hear that a lot as a method of pregnancy prevention."

At home, she talks with her own kids about health at every stage of their development. For her younger children that means using the anatomically correct names for body parts. With her teenagers, health conversation include discussions about boundaries and safe sexual encounters.

"A lot of our education in this household has been between parents and children," Chester said. "That's because I have the resources and the education to provide it. If I wasn't in this role, and hadn't been doing this for 10 years, I don't know if I would know what to say to them, honestly."

Future visions for health education in Texas

Biundo, Chester and high school student Cali Byrd want sex education to be more accessible.

Byrd said she wishes there people from the state deciding on health education would communicate with students like her.

"They need to look at it from the perspective of a child in school," Byrd said. "You can't make a law concerning how someone lives their life when you don't understand how they live their life."

Byrd also thinks there's too much left out.

"That is honestly the root of all the problems, is if we just teach, don't have sex, you're not teaching about sex," Byrd said. "I just hope we move past that and instead, actually teach them what they need to know."

The health curriculum implementation varies across districts and schools , but Chester hopes the recent changes will help more parents and kids have open conversations.

"I think people hear sexual health, and some of them get really squeamish about it," she said. "But sexual health is your understanding of your body, your basic functioning, how you're put together, why. That's really harmful to shame something that is normal."

But the opt-in policy seems to be gaining ground in Texas. A recent change from the state now requires parental permission to teach kids about child abuse, family violence, dating violence and sex trafficking .

"This really concerns us," she said. "This means that if you have a child who has been abused by their parents, that child would have to get permission from their abusers to learn about child abuse. We think this runs the risk of withholding really crucial information from the kids that need it the most."

This story is part of a partnership between NPR, KERA and Kaiser Health News.

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• Certificates, Courses and Subscriptions

Certificate Program in Social Justice and Sexuality Education

• Online - Hybrid

This course is offered in partnership with SexEd Lectures.  Sex Ed Lectures has been providing comprehensive sex education to schools since 2006, and supports school districts with curriculum development, teacher training, community engagement and policy.

Course Overview

The Certificate Program in Social Justice and Sexuality Studies offers a comprehensive exploration of the intersection between social justice and human sexuality. This interdisciplinary program provides a nuanced understanding of diverse perspectives, theories, and practices related to sexuality within the context of social justice frameworks.

Participants will delve into an array of critical topics:

• Sexuality and Social Identity: Examining the Cycle of Socialization and how sexuality intersects with various aspects of identity such as race, gender, class, and ability, and understanding the implications of these intersections on societal structures. 
• Cultural and Historical Perspectives on Sexuality: Investigating historical and cultural influences on societal perceptions of sexuality, challenging normative narratives, and examining the evolution of sexual norms across different societies.
• Sexuality Education as Social Justice: Analyzing disparities in access to sexual health resources, exploring public health policies, and discussing strategies for promoting equitable and inclusive sexuality services and promoting sexual health outcomes for all individuals. Exploring human rights, reproductive justice, consent, and the implications for marginalized communities. 

Key Takeaways

This program combines theoretical knowledge with practical applications, encouraging critical thinking and engagement with contemporary issues. Participants will have the opportunity to develop a nuanced understanding of sexuality within the broader context of social justice, empowering them to effect positive change professionally and in their communities.

• Demonstrate a comprehensive understanding of the intersections between sexuality and various dimensions of social identity (e.g., race, gender, class, ability, etc.) through informed discussions and critical analysis.
• Explore human rights, reproductive justice, disability justice, consent, and the implications for marginalized communities. 
• Develop the ability to assess and analyze considerations related to sexuality, applying historical events or real-world scenarios in the context of sexual health and human rights. 
•   Critically evaluate the historical and cultural influences on contemporary perceptions of sexuality and how these factors shape societal norms and attitudes. 
•   Assess their knowledge and skills to actively engage in advocacy and awareness efforts related to social justice in sexuality.    

Your Instructor: Tanya Bass, PhD, MS, MEd, CHES®, CSE

Tanya Bass, PhD, MS, MEd, CHES®, CSE  (she/her/hers) is the founder of the North Carolina Sexual Health Conference (NCSEXCON). She is An award-winning sexuality educator and subject matter expert in sexuality education, reproductive health, and health equity. Tanya is an alumna of North Carolina Central University’s (NCCU) Department of Public Health Education, where she has served as an adjunct instructor for several years. She is the lead instructor for Sexuality Education. She completed her PhD in Education at Widener University in the Center for Human Sexuality Studies. She is a member of the Women of Color Sexual Health Network (WoCSHN), the Association of Black Sexologists and Clinicians (ABSC), and the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). She is a Certified Health Education Specialist (CHES) and an AASECT Certified Sexuality Educator (CSE). She is a current member of the editorial board for the  American Journal of Sexuality Education.

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Relationships and sex education (RSE) and health education

Statutory guidance on relationships education, relationships and sex education (RSE) and health education.

Applies to England

Relationships Education, Relationships and Sex Education (RSE) and Health Education

PDF , 622 KB , 50 pages

Foreword by the Secretary of State

About this guidance, introduction to requirements, relationships education (primary), relationships and sex education (rse) (secondary), physical health and mental wellbeing (primary and secondary), delivery and teaching strategies, annex a: regulations for relationships education, relationships and sex education (rse) and health education, annex b: resources for relationships education, relationships and sex education (rse) and health education, annex c: cross government strategies for relationships education, relationships and sex education (rse) and health education, implementation of relationships education, relationships and sex education and health education 2020 to 2021.

This is statutory guidance from the Department for Education (DfE) issued under section 80A of the Education Act 2002 and section 403 of the Education Act 1996.

Schools must have regard to the guidance and, where they depart from those parts of the guidance which state that they should, or should not, do something, they will need to have good reasons for doing so.

This statutory guidance applies to all schools, and is for:

• governing bodies of maintained schools (including schools with a sixth-form) and non-maintained special schools
• trustees or directors of academies and free schools
• proprietors of independent schools (including academies and free schools)
• management committees of pupil referral units (PRUs)
• teachers, other school staff and school nurses
• headteachers, principals and senior leadership teams
• diocese and other faith representatives
• relevant local authority staff for reference

To help school leaders follow this statutory guidance, we have published:

• an implementation guide to help you plan and develop your curriculum
• a series of training modules to help train groups of teachers on the topics within the curriculum
• guides to help schools communicate with parents of primary and secondary age pupils

Updates to the page text to make it clear this guidance is now statutory. Updated the drugs and alcohol section of annex B to include a link to the teacher training module on drugs, alcohol and tobacco and to remove the link to the research and briefing papers. We have not made changes to any of the other guidance documents.

Added 'Implementing relationships education, relationships and sex education and health education 2020 to 2021'.

Added a link to the sex and relationship education statutory guidance.

Added link to guides for parents.

First published.

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