The Importance of Comprehensive Sexual Education
Sexual education in middle and high school is one of the first and most important prevention techniques for further public health issues. A health class could be the only exposure to sexual health information an adolescent receives due to their family status and living situation. The way sexual education is taught to an adolescent has a great impact on all areas of the individual and societal health for the rest of their lives.
It is especially important in America today because, “”the United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases”” (Stranger-Hall, 1). How do we lower this staggering figure? There have been two major schools of thought when it comes to sexual education and prevention: abstinence only and comprehensive curriculum.
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All A-H standards must be met in order to qualify for certain privileges given to abstinence programs. To be a comprehensive program, the curriculum includes information about abstinence as the only completely reliable method to prevent unwanted pregnancy and STD/STI spreading but also acknowledges the reality of adolescent sexual activity. Both forms of education also address other important topics for an adolescent’s sexual wellbeing like reproductive anatomy. In order to address the public health concern in a proximal way, a comprehensive program educates students on proper contraceptive techniques to prepare them for the likely event they will engage in premarital sexual activities.
The effect of either type of education on the rest of society is huge. If a person does not practice safe sex practices because they did not learn about topics not covered in abstinence only programs like the validity of condoms as pregnancy and disease protection they could either not use them or use them incorrectly resulting in unwanted pregnancy or and STD/STI. The repercussions of a disease or infection ranges from as short term as penicillin for syphilis or a live long problem like HIV/AIDS. Both cause an increase in need for health care services and resources that could be used otherwise.
Similarly, an unwanted teen pregnancy results in either an expensive abortion or a complete change in one or more people’s entire lives. Some teen pregnancies result in happy families that just get an early start, but some cause huge emotional, physical, and financial strain on all parties involved. A parent not yet ready to support a child in every way the child should be should not bring a life into the world. Besides the emotional and physical well being of both parent and child, they too take up more resources that could be allocated to other issues that could be prevented. A condom is cheaper than treatment for an STD or all the expnses that come with raising a child.
As an adolescent the topic of abstinent versus comprehensive sexual education is very relevant to me. Age of first instance of sex has remained relatively the same over the last few years, but in each generation the age of marriage is steadily increasing. These two taken together are resulting in higher rates of premarital sex in each generation (Santelli). An incomplete sexual education leads to unsafe practices due to lack of knowledge and further complications later on in life. Abstinence only education does not prepare the youth of today for the reality of sexual cultural norms. The current curriculum for middle and high school sexual education is outdated, religiously biased, and discriminatory against LGBTQ+ individuals.
Most Americans want a comprehensive program. According to a recent poll, “”67% of Americans say emphasizing safer sexual practices is more effective than abstinence at reducing unwanted pregnancies…and 69% say that…[it] is a better way to reduce the spread of STIs”” (Davis), yet information on contraception is only a required part of the curriculum in 18 states (Sex). Even through the majority would prefer a comprehensive curriculum, a large amount of the federal funding for sexual education is grandfathered into abstinence programs.
Since in the United States “”there is no national sexuality education curriculum…only sexuality education standards”” (Elia, 108), the sexual education of each student varies from state to state, region to region as it is interpreted by all the parties involved in deciding how the students receive the information. A way to remedy the issue of incomplete sexual education and the consequential high amounts of teen pregnancies and STD/STD incidence would be to direct more federal funding toward building evidence based, comprehensive programs and creating a national curriculum for the information taught. This would standardize the experience and make sure very student has the information necessary to make smart decisions about their own sexual well being and the impact their decisions have on others.
Historic Federal Involvement in Sexual Education
During the Reagan administration the United States was found to have a spike in teen pregnancy and congress saw a need to provide adolescents with information to prevent pregnancy. The resulting legislation was the Adolescent Family Life Act (AFLA) in 1981 which provided federal funds to religious organizations and charities to create programs that aimed to prevent teen pregnancy through promoting abstinence until marriage.
No information was provided about abortions. Due to the major religious organization funding there was a heavy Judeo-Christian bias in the curriculum. This eventually led to a supreme court case Bowen v. Kendrick that argued the programs promoted religion with federal funds and violated the separation of church and state. However, the AFLA was upheld because the goal of the program was to prevent teen pregnancy and not to spread Judeo-Christian ideals; that was seen as a side effect (Carroll).
As a part of Bill Clinton’s work repairing welfare, Title V of the Social Security Act created another avenue for federal funding of sexual education programs. In order to receive the grants, the programs must meet the above A-H criteria listed above. To bolster the federal funds, states matched 3 out of every 4 dollars the grant provided (Carroll). The focus of the approved programs was abstinence until marriage as a way of controlling the population in need of federal support from welfare.
The emphasis on a nuclear family was aimed to deter premarital sex and thus “”minimize public dependency [on welfare] rather than address the public health issue of teen pregnancy and STD rates”” (Carrol, 53). It also reinforced stereotypes that a nontraditional family unit led to poverty and ostracized the LGBT community. Teen pregnancy and STD/STI rates still continued at high rates.
In 2000 during the Bush administration, state jurisdiction over funding and consequently sexual education programs was decreased by the creation of Community Based Abstinence Education (CBAE). CBAE gave grants to programs with the same abstinence criteria as Title V, but there was no requirement for the states to match the federal funs 3 for every 4 dollars granted. Religious organizations still received a large amount of the funding and continued the nuclear family focus. Thus, the program could not mention any forms of contraception for safe sex practices.
However, in 2004 report revealed the flawed curriculum of a majority of the approved organizations “”withhold information about condoms and contraception, promotes religious ideologies and gender stereotypes, and stigmatizes adolescents with nonheteronormative sexual identities”” (Hall, 595). The curriculum on these programs was not monitored after they were given the grants and were not evidence-based interventions. This misinformation shaped the sexual health of generations of kids with flawed information and biased ideals while not meaningfully decreasing the original public health issue. States lost faith in the abstinence only model and they increasingly declined Title V funds which in turn declined the amount of abstinence only programs.
After the factual issues with the CBAE, the Obama administration started providing more funds to develop evidence-based programs which grew to include some more comprehensive ideals. One of the first of these programs was the Responsible Education About Life act which started in 2008 and provided more information on contraception and prepared students for the reality of adolescent sexual activity.
In 2009 the Teen Pregnancy Prevention initiative was created to give funds to organizations to create more evidenced based programs to curb teen pregnancies (Saunders). In order to get the Patient Protection and Affordable Care Act passed in 2010 there was an increase in Title V funds which allowed for both abstinence and evidence-based programs funds (Chinn). The emergence of more comprehensive and evidence-based programs gave student the tools they needed to make informed decisions about their sexual habits and allowed teen pregnancy rates to decline.
Current Federal, State, and Societal Influence
As recent as April of this year, the Trump administration released plans for changing the requirements for federal funding. The New York Times reported that they will “”favor those [programs] that promote abstinence and not requiring rigorous evidence of effectiveness”” (Belluck). It will not restrict comprehensive programs, but will unfortunately favor funding for those who focus more on abstinence and will not require proof of effectiveness of the program. This could revert the sexual education of the future generations to the harmful and incomplete information of past administrations. Even with major federal funding for programs, states still have a major say in how they interpret the federal policies.
According to Hall et al, “”comprehensive sex and/or STD education that includes abstinence as a desired behavior was correlated with the lowest teen pregnancy rates across states”” (Stranger-Hall, 2) and “”the more strongly abstinence is emphasized in state laws and policies, the higher the average teenage pregnancy and birth rate”” (Stranger-Hall, 6). Depending on the social standards in each region they could choose to focus on comprehensive or abstinence education and the consequential STD/STI rate and teen pregnancy rate.
The Issues with Abstinence Only
Aside from the evidence showing the relative ineffectiveness of abstinence education, there are other ethical issues with the programs. Historically, abstinence only education has come from moral judgement as the basis for curriculum and not successfully evidence-based information. The first federal funding for sexual education was reactionary to the shockingly high teen pregnancy and STD/STI rates.
Based off of societal biases and religious ideals AFLA ignored the source of the issue which was adolescent sexual behavior and attempted to patch the problem by guilting teens into not having sex. Abstinence only teaching is analogous to the Drug Abuse Resistance Education program and Nancy Reagan’s “”just say no!”” (Hornik) campaign which were some of the largest non-evidence based public health initiatives that turned out to be ineffective (West). They are similar in the way public policy was guided by biased societal norms instead of evidnce which ended up hurting the public and especially minorities.
One of the most underserved minorities in non-comprehensive sexual education programs is the LGBTQ+ community. Because most federally funded programs focused on abstinence before marriage and marriage being between a man and a woman, any nonheteronormative individual does not receive the complete information they need to be safe. A paradox forms where one of the major issues students needed to learn about (especially in the 1980’s forward through the AIDS crisis) was how using condoms could protect from then deadly diseases but they were prohibited from receiving that information.
Instead of learning valuable safe sex skills that could have prevented large amounts of infections, gay men were stigmatized and only taught information that pertained to the “”ideal”” family life. The stigmatization causes even more feelings of loneliness and isolation than is already felt by an LGTBTQ+ teen (Elia).
Abstinence only programs tend to use fear and guilt as a way to persuade students into not having sex. I can remember my health teacher freshmen year of high school showing my class a slide show horrific pictures of genitals disfigured by STD/STIs and telling us it would happen to us if we had sex. He did also mention contraceptives and showed us the stereotypical condom on the banana, but those mentions were quick. His main message was more fearmongering than useful information.
The absolute nature of abstinence education makes the ideology difficult for teenagers to follow. Many of the program have teens make a “”virginity pledge”” to themselves to promise to not have sex before marriage. It was found that making these pledges did raise the age of first sexual experience, however “”the majority of adolescents who made virginity pledges ultimately broke their promise'”” (Kohler, 350).
As stated earlier, the average age of marriage is rising while the average age of sexual debut is staying stagnant at a little under eighteen (Santelli). The two statistics taken together reinforce the unlikelihood adolescents in an increasingly progressive world will keep true to all the black and white expectations of abstinence. Rather than telling students “”this is right”” or “”that is wrong”” it is more effective as risk reduction to teach them safe skills just in case they need them.
Perceived Issues with Comprehensive Education
The major concern about providing students with education that involves controversial topics such as condoms, birth control, abortions, and even the act if sex itself is that teaching students valuable skills they need to be safe would instigate earlier sexual debut. This mainly comes from more conservative and religious areas. However, receiving comprehensive education has been found to lower “”sexual activity and frequency of sexual activity”” (Chin, 286) compared to those receiving abstinence education.
Another issue is fear that spreading awareness of contraceptives to sexually active students will make them think they are always effective. Many abstinence focused programs teach that contraceptives are unreliable and do not protect well against pregnancy and STD/STIs. In reality condoms are 85% effective as a single birth control method (Planned Parenthood). Ineffectiveness of condoms to “”provide complete protection from pregnancy and STIs…because adolescents do not use them consistently”” (Chin, 286). When used consistently and correctly contraceptives can provide excellent protection from unwanted pregnancies and diseases or infections. However, adolescents need to learn those skills in order to practice them.
The first step to remedying the extremely high rates of teen pregnancy and STD/STIs in the United States is to accept that adolescents do engage in sexual activity instead of trying to suppress it. Corrected for socioeconomic status, the more abstinence is stressed, the higher the teen birthrate (Stanger-Hall): ignoring the problem and teaching students to “”just say no”” is ineffective. After accepting teenage sex as an issue the next step is to create one national curriculum that standardizes what must be covered in all sexual education classes.
I know it would be very difficult to get some of the most vital information to be accepted in some of the more conservative states, but having students be prepared to deal with sex would be beneficial for the entire population. This curriculum would stress abstinence as the only completely safe way to prevent pregnancy and STD/STIs, but also provide other necessary information. As a risk reducing approach it would also teach students how to use and where to find condoms and other forms of birth control.
Another contentious topic included is abortion; not condemning or advocating for abortion but giving the information so the students understand the options. Instead of focusing solely on heteronormative relationships, information for the safety and inclusion of people of the LGBTQ+ community would need to be included to ensure all student’s needs are catered to.
After the national curriculum has been created using evidence-based methods, huge amounts of funding would be needed to institute the changes. One of the main barriers to successful comprehensive sexual education in the past has been “”long term financial sustainability”” (Saunders, 243). Switching from the different forms of grants now in effect that subsidize different kinds of sexual education organizations to one large program to fund the implantation of the one curriculum could streamline the process and make it simpler.
If students are provided a comprehensive sexual education then they can make informed decisions to protect them selves from STD/STIs and unwanted pregnancy. Lower rates of disease and infection mean a lower need for health care and less money spent on preventable diseases. Unwanted and teen pregnancies have a huge effect on both the quality of life of the parents, the child, and the rest of society. The federal government has great control over what get taught in schools because they control a large amount of funding.
In the past there has not been one standardized curriculum that all school must follow so there has been a large discrepancy in the quality of sexual education received in different parts of the country. A majority of the funding has gone religiously, gender, and racially biased organizations that then along with the state and school dictate the student’s sexual education. Most of these programs also focus on abstinence as the main way to prevent disease and pregnancy but that was not effective. Creating and funding one national curriculum that is evidence based and comprehensive would help fix the dilemma that costs Americans so much money, time, and happiness every day.