Only 19 US States Require School Sex Education To Be Medically Accurate, Finds Sweeping Review

Regardless of what some people may believe, sex education has been shown to be extremely important for young people. Adolescents in the US are at greater risk of sexually transmitted infections (STIs), HIV, and unintended pregnancy when compared to adults. The situation is worse for those from sexual, gender, or racial/ethnic minorities.

But sex education can make a huge difference. Evidence-based education has consistently been associated with positive sexual health outcomes, including delays to the initiation of sexual activity, fewer unintended pregnancies, more condom use, and an increased adoption of birth control. 

This approach is championed by national and international bodies alike, including the World Health Organization, the US Centers for Disease Control and Prevention, the American Public Health Association, the American Academy of Pediatrics, and the US Future of Sex Education Initiative. Research has also indicated that the vast majority of parents also support comprehensive sexual education programs in schools.

And yet the US’s approach to sex education is quite messy, resulting in a patchwork effect filled with inconsistencies and inaccuracies. These issues can confuse students, leaving them under-equipped to make informed decisions about their sexual health, relationships, or wellbeing.

In a new study intended to better grasp and assess the current sexual education laws in the US, researchers found that only 19 states out of the 42 that require public school students to take sexual education courses require them to be medically accurate. And only five of those states require medical accuracy for specific topics.

The research was led by academics at Boston University’s School of Public Health (SPH), who also found that 34 states that mandated sex education required students to learn about abstinence – an outdated method that they say has been consistently shown to be ineffective and harmful to adolescent sexual health.

It is often up to legislators, school boards, and local municipalities to decide how to interpret the requirements, which leads to highly variable and non-standardized interpretations that are subject to decider’s personal beliefs.

Kimberley Nelson, PhD, MPH

“One factor as to why states continue to prioritize abstinence-heavy curricula is because federal funds continue to predominantly support abstinence-focused approaches”, Kimberly Nelson, associate professor of community health sciences, told IFLScience.

“As such, states who use federal funding to support their sexual education programs are typically required to have an abstinence-focused approach and you see that reflected in their sexual education legislation. An additional reason has to do with the fact that state-level sociopolitical forces exert substantial influence on sexual education in each state. In states where sociopolitical forces and vocal advocacy groups push an abstinence-focused approach, that approach is likely to be seen as politically advantageous and be adopted.”

According to Nelson and colleague’s work, 34 states also allow parents to opt their children out of receiving any sexual education. Five even require parents to opt their children into such instruction.

The results show that, while many students in the US are required to get some sexual education, many fewer are likely getting the comprehensive education that public health officials and medical associations recommend. Only 58 percent of US students reside in jurisdictions requiring sexual education to be medically accurate.

“‘Medically accurate,’ like most of the attributes that are required of sexual education in state legislation (e.g., ‘age-appropriate,’ ‘up-to-date’), is often not explicitly defined in the legislation”, Nelson explained. “As such, it is often up to legislators, school boards, and local municipalities to decide how to interpret the requirements, which leads to highly variable and non-standardized interpretations that are subject to decider’s personal beliefs.”

To gain their insights, Nelson and colleagues from SPH, Cornell Law School, and Florida International University identified and examined state statutes, administrative regulations, and state court decisions mandating sexual education in public schools. They also analyzed sexual education content requirements, parental notice, and consent policies.

It seems state mandates vary across regions. For instance, all Northeastern states require school-based sexual education for at least one topic, whereas this is only the case in 88 percent of states in the South, 83 percent in the Midwest, and only 62 percent in the West. 

When it comes to specific topics, 34 states mandate schools educate students about HIV, while 32 require education about STIs, and 31 mandate education on child abuse prevention. Instruction about healthy relationships is only required in 27 states, while only 24 states require education about sexual assault, and only 21 states require instruction about dating violence or intimate partner violence.

Only 20 states require schools to teach about contraception, and just 12 mandate education about sexual orientation. Eleven require education about condoms, and only nine address consent. Two states that do mandate instruction about sexual orientation actually require schools to stigmatize or include otherwise negative messaging, including describing same-sex activity as being “primarily responsible” for AIDS.

Nelson and colleagues believe that more research is needed to understand the extent to which parental opt-in and opt-out policies limit the effect of state sexual education mandates. The same is true for parents’ rights to review or receive advance notice of sexual education curricula. However, they do acknowledge that such policies are likely political compromises that could be hard to remove.

The study is published in the American Journal of Public Health.